INTRODUCTION: Esophageal 24-hour pH/impedance testing is routinely performed to diagnose gastroesophageal reflux disease (GERD). Interpretation of these studies is time-intensive for expert physicians and has high inter-reader variability. There are no commercially available machine learning tools to assist with automated identification of reflux events in these studies.METHODS: A machine learning system to identify reflux events in 24-hour pH/impedance studies was developed, which included an initial signal processing step and a machine learning model. Gold standard reflux events were defined by a group of expert physicians. Performance metrics were computed to compare the machine learning system, current automated detection software (Reflux Reader v6.1), and an expert physician reader.RESULTS: The study cohort included 45 patients (20/5/20 patients in the training/validation/test sets, respectively). Mean age was 51 (standard deviation [SD] 14.5) years, 47% of patients were male, and 78% of studies were performed off proton pump inhibitor (PPI). Comparing the machine learning system vs. current automated software vs. expert physician reader, AUC was 0.87 (95% CI 0.85-0.89) vs. 0.40 (95% CI 0.37-0.42) vs. 0.83 (95% CI 0.81-0.86), respectively; sensitivity was 68.7% vs. 61.1% vs. 79.4%, respectively; and specificity was 80.8% vs. 18.6% vs. 87.3%, respectively.DISCUSSION: We trained and validated a novel machine learning system to successfully identify reflux events in 24-hour pH/impedance studies. Our model performance was superior to that of existing software and comparable to that of a human reader. Machine learning tools could significantly improve automated interpretation of pH/impedance studies.
View details for DOI 10.14309/ctg.0000000000000634
View details for PubMedID 37578060