Image-enhanced endoscopy is specific for the diagnosis of non-erosive gastroesophageal reflux disease

Abstract

Objectives: We assessed the performance characteristics of image-enhanced endoscopy with i-Scan or narrow band imaging (NBI) in patients with non-erosive gastroesophageal reflux disease (GERD) compared to controls without heartburn.

Material and methods: Image-enhanced endoscopic findings of vascularity at the squamocolumnar junction, distal esophageal micro-erosions, and non-round pit pattern at the squamocolumnar junction were assessed in cases (heartburn not responsive to PPIs, positive results on validated GERD questionnaire, no esophageal erosions, esophageal biopsies with histologic evidence of GERD (basal cell hyperplasia, elongation of papillae and dilation of intercellular spaces all required)) and in controls (no GERD symptoms or esophageal erosions).

Results: Twenty cases and 60 controls were compared. The pre-defined features were more common in cases vs. controls: vascularity RR = 4.9 (95% CI: 2.4–10.0), specificity = 86.7%; micro-erosions RR = 9.7 (3.6–26.5), specificity = 93.3%; non-round pit pattern RR = 2.4 (1.7–3.3), specificity = 60.0%; combination of vascularity and micro-erosions RR = 30.0 (4.1–220), specificity = 98.3%. These differences were consistent with both i-Scan and NBI.

Conclusions: Image-enhanced endoscopic findings of vascularity and micro-erosions were very specific for non-erosive GERD. Image-enhanced endoscopy may be useful in real-time diagnosis of non-erosive GERD when patients undergo upper endoscopy for heartburn. The relative utility of image-enhanced endoscopy vs. pH-impedance monitoring, based on efficacy, cost and patient acceptance, requires additional study.

Keywords:

• Gastroesophageal reflux
• heartburn
• endoscopy
• gastrointestinal
• image enhancement

Disclosure statement

Loren Laine and the Yale Section of Digestive Diseases had previously received a gift from Pentax to support clinical research. No other potential conflict of interest was reported by the authors. No outside source had any input or provided assistance on design, performance or analysis of the study or preparation of the manuscript.

Additional information

Funding

Supported by NIH T32 DK007356 (N.P.). Loren Laine and the Yale Section of Digestive Diseases also have previously received a gift from Pentax to support clinical GI research.