Limitations of Gold Standards for Diagnosing Gastroesophageal Reflux Disease
Bibliographic record
Abstract
Letters19 October 2004Limitations of Gold Standards for Diagnosing Gastroesophageal Reflux DiseaseKaveh G. Shojania, MDKaveh G. Shojania, MDFrom University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-8-200410190-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Numans ME, Lau J, de Wit NJ, Bonis PA. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med. 2004;140:518-27. [PMID: 15068979] LinkGoogle Scholar2. Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, et al . The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996;111:85-92. [PMID: 8698230] CrossrefMedlineGoogle Scholar3. Kusano M, Ino K, Yamada T, Kawamura O, Toki M, Ohwada T, et al . Interobserver and intraobserver variation in endoscopic assessment of GERD using the “Los Angeles” classification. Gastrointest Endosc. 1999;49:700-4. [PMID: 10343212] CrossrefMedlineGoogle Scholar4. Franzen T, Grahn LT. Reliability of 24-hour oesophageal pH monitoring under standardized conditions. Scand J Gastroenterol. 2002;37:6-8. [PMID: 11843037] CrossrefMedlineGoogle Scholar5. Carlsson R, Dent J, Bolling-Sternevald E, Johnsson F, Junghard O, Lauritsen K, et al . The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol. 1998;33:1023-9. [PMID: 9829354] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoShort-Term Treatment with Proton-Pump Inhibitors as a Test for Gastroesophageal Reflux Disease Mattijs E. Numans , Joseph Lau , Niek J. de Wit , and Peter A. Bonis Limitations of Gold Standards for Diagnosing Gastroesophageal Reflux Disease Mattijs E. Numans , Peter A. Bonis , and Joseph Lau Metrics 19 October 2004Volume 141, Issue 8Page: 648KeywordsEndoscopyFallsGastroesophageal reflux diseaseProton pump inhibitorsQuestionnairesSpecificityStable coronary artery disease ePublished: 19 October 2004 Issue Published: 19 October 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.629 | 0.753 |
| Meta-epidemiology (narrow) | 0.002 | 0.003 |
| Meta-epidemiology (broad) | 0.006 | 0.005 |
| Bibliometrics | 0.012 | 0.006 |
| Science and technology studies | 0.002 | 0.009 |
| Scholarly communication | 0.011 | 0.007 |
| Open science | 0.010 | 0.006 |
| Research integrity | 0.007 | 0.009 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".