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Narrow Band Imaging for Diagnosis of Non-Erosive Reflux Disease
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND AND AIMS
To examine the accuracy of narrow band imaging(NBI) findings in non-erosive reflux disease(NERD) patients compared to controls and the impact of proton pump inhibitor therapy(PPI) on these mucosal changes in a multi-center, double-blind, randomized controlled trial.
METHODS
NERD patients(typical symptoms using validated GERD questionnaire, absence of erosive esophagitis and abnormal 48-hour pH study) and controls underwent high-definition white light endoscopy followed by NBI and biopsies of the distal esophagus. Then, NERD patients were randomized to esomeprazole 40 mg per day or placebo for 8 weeks, followed by repeat endoscopy. Presence of distal esophageal mucosal changes on NBI were recorded at baseline and after treatment - intrapapillary capillary loops(IPCL; number, dilation, and tortuosity), micro-erosions, increased vascularity, columnar islands, and ridge villous pattern(RVP) above squamocolumnar junction.
RESULTS
Of 122 screened, 21 NERD and 21 controls were identified: age 49.5+/- 14.6years, 62%males, 85%Caucasians. Combination of IPCL tortuosity, RVP and micro-erosions(62% vs 19%, p<0.05) had a high specificity(86%) and moderate sensitivity(60%) for NERD with an area-under-the-curve=0.74. In NERD patients treated with PPI(n=10), resolution of micro-erosions was most significant(p=0.047) compared to placebo(n=11). RVP resolved in all NERD patients after therapy(p=0.02) and correlated with acid exposure time(p=0.004). Papillary length(p=0.02) and basal cell thickness(p=0.02) significantly correlated with a combination of IPCL tortuosity, RVP and micro-erosions.
CONCLUSIONS
In this RCT, ridge-villous pattern on NBI demonstrated a high specificity, correlated with acid exposure time and improved with proton pump inhibitor therapy suggesting that it could be used as a surrogate marker for diagnosis of non-erosive reflux disease.(Clinicaltrials.gov: NCT02081404).
Additional Info
Disclosure statements are available on the authors' profiles:
Narrow Band Imaging for Diagnosis of Non-Erosive Reflux Disease: An International, Multicenter, Randomized Controlled Trial
Gastrointest. Endosc. 2022 Apr 26;[EPub Ahead of Print], M Desai, S Srinivasan, S Sundaram, C Dasari, N Andraws, S Mathur, A Higbee, J Miller, S Beg, W Fateen, SS Sami, A Repici, K Ragunath, P SharmaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Gastroesophageal reflux disease (GERD) is a common disorder.1 Around 14% of adults experience symptoms of GERD, and more than half of them exhibit normal esophageal mucosa on upper endoscopy, making non-erosive reflux disorder (NERD) the most common subtype of GERD seen in daily practice.2 Proton pump inhibitors (PPIs) are the mainstay of treatment with the goal of symptoms relief. Clinical symptoms, positive esophageal PH monitoring study, and normal endoscopy help to establish the diagnosis NERD.3
In this study, Desai et al screened 122 patients who met inclusion criteria and had completed the GERDQ questionnaire underwent endoscopy. After exclusion, there were 21 patients diagnosed with NERD randomized to either PPI treatment—esomeprazole 40 mg per day—or placebo for 8 weeks at two medical centers with a follow-up endoscopy at the end of the treatment period.
The authors reported a significant resolution of microerosions in patients treated with PPIs when compared with those treated with placebo (P = .047). Moreover, the ridge villous pattern (RVP) in patients with NERD treated with PPI showed statistically significant resolution (P = .02), with RVP correlated with acid exposure time (P = .004). The study opens up exciting prospects for using NBI findings, especially RVP, as a marker for diagnosis of NERD.
References