ORIGINAL RESEARCH article
Front. Med.
Sec. Gastroenterology
Diagnostic Accuracy of Gastric Filling Ultrasound Combined with BMI for Gastroesophageal Reflux Disease
Feng Tang
Huizhen Yu
Tianjun Zhao
Lin Lin
Pei wen Dong
Kai di Sun
Xiaobin Sun
Qiong Wang
Chengdu Third People's Hospital, Chengdu, China
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Abstract
Purpose: To evaluate the diagnostic accuracy of gastric filling ultrasound combined with body mass index (BMI) in dynamic assessment of gastroesophageal reflux in patients with gastroesophageal reflux disease (GERD)-like symptoms, using 24-hour pH impedance-monitoring and esophagogastroduodenoscopy (EGD) as reference standards. Method: We enrolled 155 patients with GERD-like symptoms in our hospital. The results of gastric filling ultrasound combined with BMI were compared to 24-hour pH impedance-monitoring and EGD to assess GERD. Diagnostic accuracy was assessed via sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's kappa statistics. The Calibration curve was performed to assess agreement between the predicted probabilities of the model and the observed outcomes. Decision Curve Analysis (DCA) was performed to evaluate clinical utility. Result: GERD patients exhibited significant differences in age, BMI, His angle and all reflux-related metrics (P<0.05). The BMI-based gastric filling ultrasound composite score demonstrated an area under the curve of 0.826 with an optimal cutoff of 4.50. Using this threshold, scores 6-8 defined as GERD, sensitivity was 83.75%, specificity was 65.33%, PPV 72.04%, NPV 79.03% and overall accuracy 74.84%. The observed agreement was 0.75, expected agreement was 0.50 and the Kappa was 0.494. The calibration curve indicated good agreement between the predicted probabilities of the model and the observed outcomes, with a mean absolute error of 0.034. Decision curve analysis demonstrated that the model provided a superior net benefit over both the "treat all" and "treat none" strategies across a wide range of clinically relevant threshold probabilities (approximately 10% to 65%). Conclusion: Gastric filling ultrasound is a dynamic imaging technique that visualizes symptoms in GERD patients. The BMI-based gastric filling ultrasound, given its good correlation with 24-hour pH impedance monitoring, is promising auxiliary diagnostic tool for GERD.
Summary
Keywords
24-hour pH impedance-monitoring, BMI, Diagnostic accuracy, Gastric filling ultrasound, Gastroesophageal reflux disease
Received
18 October 2025
Accepted
27 January 2026
Copyright
© 2026 Tang, Yu, Zhao, Lin, Dong, Sun, Sun and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Feng Tang
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