From the Guidelines
The DeMeester score is a measure used to assess the severity of gastroesophageal reflux disease (GERD) based on 24-hour pH monitoring results, with a score above 14.7 considered abnormal, but more recent evidence suggests that a score of ≥ 50 indicates a more severe phenotype of GERD. To calculate the DeMeester score, six parameters are evaluated:
- Total number of reflux episodes
- Number of reflux episodes lasting longer than 5 minutes
- Duration of the longest reflux episode
- Total time pH < 4
- Percentage of time pH < 4 in upright position
- Percentage of time pH < 4 in supine position The score is automatically calculated by pH monitoring software using a formula that weighs these parameters, as noted in the study by Yadlapati et al. 1. Higher scores indicate more severe reflux, and a score of ≥ 50, as mentioned in the study by Yadlapati et al. 1 and further supported by the study 1, is associated with a more severe manifestation of GERD, including advanced grade esophagitis (Los Angeles grade C or D), bipositional reflux, or large hiatal hernia. This score is valuable for objectively quantifying acid reflux and guiding treatment decisions, as it can help determine if a patient's symptoms are truly related to acid reflux and whether more aggressive interventions, such as anti-reflux surgery, may be warranted, as suggested by the study 1. While useful, the DeMeester score should be interpreted alongside clinical symptoms and other diagnostic tests for a comprehensive evaluation of GERD.
From the Research
Definition of DeMeester Score
The DeMeester score is a composite score used to quantify acid exposure during prolonged ambulatory pH monitoring 2, 3, 4, 5, 6. It is calculated based on several parameters, including the percentage of total time with a pH below 4, the percentage of upright time with a pH below 4, and the percentage of recumbent time with a pH below 4.
Calculation and Interpretation
The DeMeester score is used to categorize patients as having gastroesophageal reflux disease (GERD) or not 2, 5. A higher DeMeester score indicates more severe acid reflux. The score is calculated using a formula that takes into account the duration and frequency of acid reflux episodes 3.
Clinical Significance
The DeMeester score is used to diagnose and assess the severity of GERD 2, 5. It is also used to evaluate the effectiveness of treatments, such as proton pump inhibitors (PPIs) 3 and laparoscopic Nissen fundoplication 6. A positive DeMeester score is associated with an increased likelihood of having esophageal symptoms, such as heartburn 2.
Limitations and Strengths
The DeMeester score has some limitations, including its inability to detect non-acid reflux and its limited correlation with symptom severity 4, 5. However, it remains a reliable method for diagnosing and assessing the severity of GERD 5. The score is also useful for identifying patients who are likely to benefit from treatments, such as PPIs and fundoplication 3, 6.
Key Points
- The DeMeester score is a composite score used to quantify acid exposure during pH monitoring 2, 3, 4, 5, 6.
- The score is used to diagnose and assess the severity of GERD 2, 5.
- A higher DeMeester score indicates more severe acid reflux 3.
- The score has limitations, including its inability to detect non-acid reflux and its limited correlation with symptom severity 4, 5.