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Associations between endoscopic findings and functional assessment via multichannel intraluminal impedance–pH monitoring in patients with non-erosive reflux disease refractory to proton-pump inhibitors

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Abstract

Background and aim

The clinical significance of minimal changes in non-erosive reflux disease (NERD) is controversial. Multichannel intraluminal impedance–pH (MII-pH) monitoring enables classification of NERD. The aim of this study was to evaluate associations between endoscopic findings and functional assessment via MII-pH monitoring in patients with proton-pump inhibitor (PPI)-refractory NERD.

Methods

Thirty-four PPI-refractory NERD patients were retrospectively analyzed. On the basis of the MII-pH monitoring results, cases were classified as acid reflux, non-acid reflux, and functional heartburn. Minimal changes such as white turbidity, erythema, loss of fine vascular network pattern at the esophagogastric junction, hyperplasia of vascular network at the middle esophagus, hernia, flap valve grade, and atrophic gastritis were evaluated endoscopically.

Results

Among 34 patients, 8 were categorized with acid reflux, 17 with non-acid reflux, and 9 with functional heartburn. There were no differences in the prevalence of minimal changes among the groups, but all cases showing white turbidity of the entire esophageal circumference involved non-acid reflux. The prevalence of hiatal hernia and abnormal flap valve did not differ among the three groups, but the presence of atrophic gastritis was significantly more common in patients with functional heartburn than in those with acid and non-acid reflux. The prevalence of hyperplasia of the vascular network at the middle esophagus was significantly higher in patients with proximal migration than in those without.

Conclusion

There are associations between endoscopic findings and functional assessment via MII-pH monitoring. Future studies should pay more attention to the endoscopic findings at the middle esophagus.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interest

All authors, Y. Fujiwara, Y. Kohata, T. Tanigawa, H. Yamagami, M. Shiba, K. Tominaga, T. Watanabe, T. Arakawa, declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan

    Yasuhiro Fujiwara, Yukie Kohata, Tetsuya Tanigawa, Hirokazu Yamagami, Masatsugu Shiba, Kazunari Tominaga, Toshio Watanabe & Tetsuo Arakawa

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  1. Yasuhiro Fujiwara
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  2. Yukie Kohata
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  3. Tetsuya Tanigawa
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  4. Hirokazu Yamagami
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  5. Masatsugu Shiba
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  6. Kazunari Tominaga
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  7. Toshio Watanabe
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  8. Tetsuo Arakawa
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Correspondence to Yasuhiro Fujiwara.

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Fujiwara, Y., Kohata, Y., Tanigawa, T. et al. Associations between endoscopic findings and functional assessment via multichannel intraluminal impedance–pH monitoring in patients with non-erosive reflux disease refractory to proton-pump inhibitors. Esophagus 12, 244–250 (2015). https://doi.org/10.1007/s10388-014-0480-2

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  • DOI: https://doi.org/10.1007/s10388-014-0480-2

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