Background and study aims: This study tested the diagnostic value of high-resolution endoscopy for the recognition
of subtle diagnostic esophageal mucosal changes in nonerosive reflux disease.
Patients and methods: Ten control subjects and eleven patients with nonerosive reflux disease confirmed
by a validated questionnaire, standard endoscopy, and 24-hour pH-metry participated
in the study. Still images were collected by high-resolution endoscopes from the distal
esophagus in a standardized manner, incorporating iodine staining. Assessments were
repeated in the patients with reflux disease after 4 weeks of esomeprazole therapy.
Interobserver variability in the recognition of the proposed criteria was initially
evaluated by 27 endoscopists using an Internet-based process. After optimisation of
image quality the evaluation was repeated face-to-face with six expert endoscopists.
Results: No criterion was identified in either assessment that was sufficiently sensitive
and specific to patients with reflux disease to be clinically useful. The kappa value,
used to assess interobserver variation, was acceptably high only for invisibility
of palisade vessels (0.59). Triangular indentations, apical mucosal breaks, and pinpoint
blood vessels at the squamocolumnar junction were identified more frequently in the
patients with reflux disease (P < 0.05). These changes and the invisibility of the palisade vessels were significantly
less prevalent in reflux patients after therapy (P < 0.01).
Conclusions: Though some distal esophageal mucosal appearances observed with the high-resolution
endoscope appeared to be related to nonerosive esophageal mucosal injury, none of
these changes proved to be sufficiently sensitive and specific to justify their use
as a diagnostic criterion for nonerosive reflux disease.
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A. Edebo, MD
Department of Gastro-Surgical Research
Sahlgrenska University Hospital
413 45 Göteborg, Sweden
Fax: + 46-31-411882
Email: anders.edebo@surgery.gu.se
