Kaveh G. Shojania, MD
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Shojania K.; Limitations of Gold Standards for Diagnosing Gastroesophageal Reflux Disease. Ann Intern Med. 2004;141:648. doi: 10.7326/0003-4819-141-8-200410190-00019
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Published: Ann Intern Med. 2004;141(8):648.
TO THE EDITOR:
The meta-analysis by Numans and colleagues (1), while well-designed in itself, suffers from limitations of the gold standards used to diagnose gastroesophageal reflux disease (GERD). Many patients with heartburn have normal findings at endoscopy. Conversely, results of esophageal pH monitoring fall within the normal range in a substantial minority of patients whose endoscopic findings indicate GERD. Moreover, both tests suffer from inter- and intraobserver variation (2-4). Similar limitations almost certainly apply to structured symptom questionnaires, which may even have poor specificity (5). Thus, the findings of Numans and colleagues (1) probably reveal more about the gold standards used to diagnose GERD than the utility of the “proton-pump inhibitor (PPI) test.”
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