ArticleTherapeutic advances in gastroenterology2026
Does the pHoenix score reduce the inconclusive GERD diagnosis: a net reclassification index analysis.
Article in Therapeutic advances in gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acid exposure time (AET) yields inconclusive results in 10%-15% of patients undergoing 24-h ambulatory pH-impedance monitoring (multichannel intraluminal impedance-pH, MII-pH) for suspected gastroesophageal reflux disease (GERD), delaying diagnosis and appropriate management. The pHoenix score (pHx-s) was developed to reduce this diagnostic uncertainty. Its performance in Latin American populations remains uncharacterized. Design: Net reclassification index (NRI) analysis based on a retrospective cohort. Methods: A cohort of symptomatic adults who underwent high-resolution manometry, MII-pH, and upper endoscopy at Hospital Universitario San Ignacio, Bogotá (Colombia) was included. pHx-s was calculated as (upright AET × 0.991) + (supine AET × 1.286) and classified as normal (<7.06), borderline (7.06-8.45), or pathological (>8.45). Diagnostic performance and area under the receiver operating curve (AUC) were calculated. DeMeester score (>14.7) served as the reference standard. NRI analysis is presented independently for patients with and without confirmed GERD. Results: 292 patients were included in the analysis (Median 61 years, 71.2% female, 79.1% with hiatal hernia (HH)). The AUC of pHx-s was 0.98 (0.963-0.992). At the lower threshold (7.06), sensitivity was 95.7% and specificity 99.1%; at the upper (⩾8.45), sensitivity 89.8%, and specificity 100%. pHx-s reduced inconclusive results from 13.0% (using exclusively AET criteria) to 4.1% (-68.5%, Conclusion: In this Latin American cohort with a high prevalence of HH, pHx-s substantially reduced inconclusive GERD diagnoses and demonstrated excellent performance compared with the DeMeester score. These findings support the use of the pHx-s in diverse clinical settings.
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