Su1508 Reliable Endoscopic Findings of Minimal Change Esophagitis for Diagnosis of Non-Erosive Reflux Disease (NERD) Using High Definition Endoscopy With I-Scan

Abstract

Background and Aims: Majority of patients with gastro-esophageal reflux disease (GERD) were nonerosive reflux disease (NERD). High definition (HD) endoscopy with I-scan could enhance visualization of mucosal and vascular pattern and might identify changes that were invisible at standard endoscopy. This study aimed to evaluate the endoscopic findings that may have diagnostic value for the prediction of NERD by using HD endoscopy with I-scan. Methods: Patients with typical GERD symptoms and healthy control without GERD symptoms were included and 2 validated GERD questionnaires were completed. The endoscopist was blinded to the presence of reflux symptoms and distal esophagus was examined by using standard white light endoscopy followed by I-scan. Mucosal morphology at squamocolumnar junction (SCJ) observed by I-scan were compared between GERD patients and controls. Results: Twenty-seven patients with reflux symptoms and 21 controls were included. Three patients with reflux symptoms had erosive reflux disease (ERD) and 24 had NERD. Gastric pit pattern adjacent to SCJ, triangular indentation, hyperemia (erythema), micro-erosion, scar and groove at SCJ (Trench sign) were clearly seen by HD endoscopy with I-scan. Comparing to controls, NERD had a significantly higher prevalence of Trench sign (ERD, 100%; NERD, 79.17%; controls, 23.81%) (p <0.001), higher prevalence of gyrus gastric pit pattern (ERD, 100 %; NERD, 87.50 %; controls, 57.14 %) (p = 0.041). The erythema at EGJ was also more common in NERD group (p = 0.041). The micro-erosions were found more often in NERD than control (29.17% vs. 4.76%) and scar was found only in NERD groups. The symptoms scores of all three groups were improved significantly after 2 weeks of PPI therapy. Conclusions: Minimal change esophagitis (Trench sign, gyrus gastric pit pattern at SCJ and erythema) observed by HD endoscopy with I-scan could be used as reliable predictors to distinguished NERD patients from normal controls. Further studies are needed to validate these findings.