Background and Aims
We examined the accuracy of narrow-band imaging (NBI) findings in nonerosive reflux
disease (NERD) patients compared with control subjects and the impact of proton pump
inhibitor (PPI) therapy on these mucosal changes in a multicenter, double-blind, randomized
controlled trial.
Methods
NERD patients (typical symptoms using a validated GERD questionnaire, absence of erosive
esophagitis, and abnormal 48-hour pH study) and control subjects underwent high-definition
white-light endoscopy followed by NBI and biopsy sampling of the distal esophagus.
Then, NERD patients were randomized to esomeprazole 40 mg/day or placebo for 8 weeks,
followed by repeat endoscopy. The presence of distal esophageal mucosal changes on
NBI were recorded at baseline and after treatment: intrapapillary capillary loops
(IPCLs; number, dilation, and tortuosity), microerosions, increased vascularity, columnar
islands, and ridge/villous pattern (RVP) above the squamocolumnar junction.
Results
Of 122 screened, 21 NERD and 21 control subjects were identified (mean age, 49.5 ±
14.6 years; 62% men; and 85% white). The combination of IPCL tortuosity, RVP, and
microerosions (62% vs 19%, P < .05) had a high specificity (86%) and moderate sensitivity (60%) for NERD with
an area under the curve of .74. In 10 NERD patients treated with PPIs, resolution
of microerosions was most significant (P = .047) compared with placebo (n = 11). RVP resolved in all NERD patients after therapy
(P = .02) and correlated with acid exposure time (P = .004). Papillary length (P = .02) and basal cell thickness (P = .02) significantly correlated with a combination of IPCL tortuosity, RVP, and microerosions.
Conclusions
In this randomized controlled trial, RVP on NBI demonstrated a high specificity, correlated
with acid exposure time, and improved with PPI therapy, suggesting that it could be
used as a surrogate marker for diagnosis of NERD. (Clinical trial registration number:
NCT02081404.)
Abbreviations:
GERDQ (GERD questionnaire), IPCL (intrapapillary capillary loop), NBI (narrow-band imaging), NERD (nonerosive reflux disease), PPI (proton pump inhibitor), RVP (ridge/villous pattern), SCJ (squamocolumnar junction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 26, 2022
Accepted:
April 20,
2022
Received:
February 14,
2022
Footnotes
DISCLOSURE: The following authors disclosed financial relationships: K. Ragunath: Consultant for Olympus and Boston Scientific. P. Sharma: Consultant for Medtronic, Olympus, Boston Scientific, Fujifilm, Salix Pharmaceuticals, and Lumendi; grant support from Ironwood, Erbe, Docbot, Cosmo Pharmaceuticals, and CDX Labs. M. Desai: Grant support from Intercept Pharma. All other authors disclosed no financial relationships.
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© 2022 by the American Society for Gastrointestinal Endoscopy
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- Obtaining slight changes for the detection of nonerosive reflux disease needs assistance from magnifying endoscopy with narrow-band imagingGastrointestinal EndoscopyVol. 96Issue 6
- PreviewNonerosive reflux disease (NERD) is a subtype of GERD that is difficult to identify because of negative endoscopic findings. Narrow-band imaging (NBI) may provide a solution to this problem. The randomized controlled trial by Desai et al1 confirmed that the morphologic characteristics of intrapapillary capillary loops (IPCLs) detected by NBI were favorable for predicting NERD. However, most other studies have used magnifying endoscopy with NBI (ME-NBI) to detect the morphologic features of IPCL.
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