Brief Article
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World J Gastroenterol. Dec 7, 2013; 19(45): 8391-8397
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8391
Investigation of relationships among gastroesophageal reflux disease subtypes using narrow band imaging magnifying endoscopy
Jing Lv, Dong Liu, Shi-Yang Ma, Jun Zhang
Jing Lv, Dong Liu, Shi-Yang Ma, Jun Zhang, Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University School of Medicine, Xi’an 710004, Shaanxi Province, China
Author contributions: Zhang J provided the original idea of the research, was the principal investigator and guarantor of this project, designed the research, performed all the endoscopic procedures and gave guidance to other parts of the research; Lv J contributed to the conception and design of the research; Lv J and Liu D contacted the potential participants, conducted screening interviews, arranged the participation of enrolled subjects and collected and analyzed the data; Zhang J critically reviewed these data; Ma SY was the blinded experienced endoscopist who assessed the images obtained during the study; Lv J wrote the manuscript, with contributions from Ma SY; Zhang J critically reviewed the paper and suggested revisions.
Supported by The Key Clinical Projects for Affiliated Hospitals of Ministry of Health of China [2007]-353
Correspondence to: Jun Zhang, MD, PhD, Professor, Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University School of Medicine, 157 Xi Wu Road, Xi’an, Shaanxi 710004, China. jun3z@163.com
Telephone: +86-29-87679305 Fax: +86-29-87679611
Received: June 19, 2013
Revised: September 24, 2013
Accepted: October 19, 2013
Published online: December 7, 2013
Processing time: 182 Days and 9.8 Hours
Abstract

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.

Keywords: Gastroesophageal reflux; Gastroesophageal reflux disease; Intrapapillary capillary loops; Magnifying endoscopy; Narrow band imaging

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.