ArticleNeurogastroenterology and motility2026
Inter-Observer Variability of Gerd-Related Metrics on High-Resolution Manometry and Calculation of the Milan Score.
Article in Neurogastroenterology and motility, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHigh-resolution manometry (HRM) is increasingly used to assess risk of gastroesophageal reflux disease (GERD). The Milan Score (MS) integrates four HRM variables-EGJ morphology, EGJ contractile integral (EGJ-CI), ineffective esophageal motility (IEM), and straight leg raise (SLR) response-to predict pathological esophageal acid exposure. The inter-observer reproducibility of the MS and its components has never been formally assessed.
methodsA total of 50 consecutive HRM plots from patients undergoing evaluation for suspected GERD at a tertiary referral center were distributed to a multicenter pool of esophageal experts for blind review. Participants assessed EGJ type, EGJ-CI, IEM, and SLR response; the MS and corresponding GERD risk were automatically calculated. Inter-observer variability was evaluated using Fleiss' κ for categorical variables and Kendall's coefficient for continuous variables. MS accuracy was assessed by comparing calculated scores against MII-pH results.
resultsTwenty-three esophageal experts from 16 international institutions reviewed all 50 plots. Agreement was fair for EGJ morphology (κ = 0.321), moderate for SLR (W = 0.531), and good for IEM (κ = 0.638), EGJ-CI (W = 0.675) and the final MS (W = 0.641). Median plot-level concordance between MS and pH-impedance study was 71.74% [IQR 51.08%]; median reader accuracy for Milan Score was 64% [IQR 12%], ranging from 54% to 80%.
conclusionsInter-observer variability of the Milan Score is good across a diverse international cohort of esophageal experts, supporting its reproducibility as a clinical tool. However, agreement for individual parameters was heterogeneous, and the assessment of EGJ morphology and the SLR maneuver achieved only fair-to-moderate agreement, highlighting the need for improved standardization.
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