Abstract :
Background and Aims: Majority of patients with gastro-esophageal reflux disease (GERD) were nonerosive
reflux disease (NERD). High definition (HD) endoscopy with I-scan could enhance visualization of mucosal
and vascular pattern and might identify changes that were invisible at standard endoscopy. This study aimed
to evaluate the endoscopic findings that may have diagnostic value for the prediction of NERD by using HD
endoscopy with I-scan.
Methods: Patients with typical GERD symptoms and healthy control without GERD symptoms were
included and 2 validated GERD questionnaires were completed. The endoscopist was blinded to the presence of
reflux symptoms and distal esophagus was examined by using standard white light endoscopy followed by I-scan.
Mucosal morphology at squamocolumnar junction (SCJ) observed by I-scan were compared between GERD
patients and controls.
Results: Twenty-seven patients with reflux symptoms and 21 controls were included. Three patients
with reflux symptoms had erosive reflux disease (ERD) and 24 had NERD. Gastric pit pattern adjacent to SCJ,
triangular indentation, hyperemia (erythema), micro-erosion, scar and groove at SCJ (Trench sign) were clearly
seen by HD endoscopy with I-scan. Comparing to controls, NERD had a significantly higher prevalence of Trench
sign (ERD, 100%; NERD, 79.17%; controls, 23.81%) (p <0.001), higher prevalence of gyrus gastric pit pattern
(ERD, 100 %; NERD, 87.50 %; controls, 57.14 %) (p = 0.041). The erythema at EGJ was also more common in
NERD group (p = 0.041). The micro-erosions were found more often in NERD than control (29.17% vs. 4.76%)
and scar was found only in NERD groups. The symptoms scores of all three groups were improved significantly
after 2 weeks of PPI therapy.
Conclusions: Minimal change esophagitis (Trench sign, gyrus gastric pit pattern at SCJ and erythema)
observed by HD endoscopy with I-scan could be used as reliable predictors to distinguished NERD patients from
normal controls. Further studies are needed to validate these findings. |
file/Thai-Journal-of-gastroenterology-vol-13-no-2-215466.pdf