Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8391
Revised: September 24, 2013
Accepted: October 19, 2013
Published online: December 7, 2013
Processing time: 182 Days and 9.8 Hours
AIM: To investigate the relationships among subtypes of gastroesophageal reflux disease (GERD) using narrow band imaging (NBI) magnifying endoscopy.
METHODS: A reflux disease questionnaire was used to screen 120 patients representing the three subtypes of GERD (n = 40 for each subtypes): nonerosive reflux disease (NERD), reflux esophagitis (RE) and Barrett’s esophagus (BE). NBI magnifying endoscopic procedure was performed on the patients as well as on 40 healthy controls. The demographic and clinical characteristics, and NBI magnifying endoscopic features, were recorded and compared among the groups. Targeted biopsy and histopathological examination were conducted if there were any abnormalities. SPSS 18.0 software was used for all statistical analysis.
RESULTS: Compared with healthy controls, a significantly higher proportion of GERD patients had increased number of intrapapillary capillary loops (IPCLs) (78.3% vs 20%, P < 0.05), presence of microerosions (41.7% vs 0%, P < 0.05), and a non-round pit pattern below the squamocolumnar junction (88.3% vs 30%, P < 0.05). The maximum (228 ± 4.8 vs 144 ± 4.7, P < 0.05), minimum (171 ± 3.8 vs 103 ± 4.4, P < 0.05), and average (199 ± 3.9 vs 119 ± 3.9, P < 0.05) numbers of IPCLs/field were also significantly greater in GERD patients. However, comparison among groups of the three subtypes showed no significant differences or any linear trend, except that microerosions were present in 60% of the RE patients, but in only 35% and 30% of the NERD and BE patients, respectively (P < 0.05).
CONCLUSION: Patients with GERD, irrespective of subtype, have similar micro changes in the distal esophagus. The three forms of the disease are probably independent of each other.
Core tip: Gastroesophageal reflux disease (GERD) has been diagnosed with conventional endoscopy and 24-h esophageal pH monitoring. There are three forms of GERD: nonerosive reflux disease (NERD), reflux esophagitis (RE) and Barrett’s esophagus (BE). However, whether GERD is a spectrum of diseases or a “tripartite” disease remains unclear. Using narrow band imaging agnifying endoscopy, we observed no significant differences in the lower esophagus among patients with the three forms of GERD. There was also no increasing trend from NERD, RE to BE, indicating that these subtypes might be independent of each other. Thus, GERD is a “tripartite” disease, rather than a spectrum of diseases.