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From DeMeester, T.R., and Stein, H.J.: Gastroesophageal reflux disease. In F.G., Jones, R.S., Kelly, K.A., et al. (eds.): Surgical Treatment of Digestive Disease, 2nd ed. Chicago, Year Book Medical Publishers, 1989, p. 65, with permission.

Figure 6-36 Graphic display of the median and ninety-fifth percentile levels in 50 normal individuals for pH thresholds above and below 6. The black area represents measurements made in the patient. The lower line shows the median and the upper line the ninety-fifth percentile value for the 50 normal subjects. When the black area exceeds the ninety-fifth percentile line for a given pH threshold, the patient has an abnormal value for the component measured. A, Percentage cumulative exposure for total time. B, Percentage cumulative exposure for upright time. C, Percentage cumulative exposure for supine time. D, Number of episodes. E, Number of episodes greater than 5 minutes in length. F, Length of longest episode. (From DeMeester, T.R., and Stein, H.J.: Gastroesophageal reflux disease. In Moody, F.G., Jones, R.S., Kelly, K.A., etal. feds. J: Surgical Treatment of Digestive Disease, 2nd ed. Chicago, Year Book Medical Publishers, p. 67, 1989, with permission.)

Figure 6-36 Graphic display of the median and ninety-fifth percentile levels in 50 normal individuals for pH thresholds above and below 6. The black area represents measurements made in the patient. The lower line shows the median and the upper line the ninety-fifth percentile value for the 50 normal subjects. When the black area exceeds the ninety-fifth percentile line for a given pH threshold, the patient has an abnormal value for the component measured. A, Percentage cumulative exposure for total time. B, Percentage cumulative exposure for upright time. C, Percentage cumulative exposure for supine time. D, Number of episodes. E, Number of episodes greater than 5 minutes in length. F, Length of longest episode. (From DeMeester, T.R., and Stein, H.J.: Gastroesophageal reflux disease. In Moody, F.G., Jones, R.S., Kelly, K.A., etal. feds. J: Surgical Treatment of Digestive Disease, 2nd ed. Chicago, Year Book Medical Publishers, p. 67, 1989, with permission.)

Figure 6-37 Concept of using the standard deviation as the scoring unit to score the component percentage time pH <4 for the total period. Note the establishment of an abstract zero point 2 standard deviations below the mean value for total-period acid exposure measured in normals. Theoretically, this allows scoring the measurement in patients as though the normal values were parametric. By this method, a patient who had a total acid exposure below pH 4 of 4.8% would have a score for this component of 4.41. (From DeMeester, T.R., and Stein, H.J.: Gastroesophageal reflux disease. In Moody, F.G., Jones, R.S., Kelly, K.A., et al. [eds.]: Surgical Treatment of Digestive Disease, 2nd ed. Chicago, Year Book Medical Publishers, p. 67, 1989, with permission.)

Figure 6-38 The composite score used to express the overall pH result. The lower line represents the median score and the upper line the ninety-fifth percentile of 50 normal subjects. The black area represents the composite score of the patient in Figure 6-34 with increased esophageal acid exposure measured at pH of <4. (From DeMeester, T.R., and Stein, H.J.: Gastroesophageal reflux disease. In Moody, F.G., Jones, R.S., Kelly, K.A., etal. feds. J: Surgical Treatment of Digestive Disease, 2nd ed. Chicago, Year Booh Medical Publishers, p. 67, 1989, with permission.)

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