Endoscopic Esophagitis and Gastroesophageal Flap Valve

Abstract

The authors studied the relationship of endoscopic esophagitis and gastroesophageal flap valve (GEFV) in patients with symptomatic gastroesophageal reflux (GER). On endoscopy, the GEFV was graded as I to IV in 138 patients with acid regurgitation and heartburn relieved by antacids, and in 54 control subjects without symptoms suggestive of GER. Grade of GEFV was correlated with the grade of esophagitis, response to medical treatment, duration of symptoms, obesity, smoking, sex, and age of the patient. Abnormal GEFV (grades III and IV) was more frequent in patients with symptomatic GER, both with and without esophagitis, compared with control subjects (p = 0.000001. p = 0.03). Abnormal GEFV was significantly more common in patients with GER with esophagitis compared with those without (p < 0.00001). There was no significant difference in the distribution of normal and abnormal GEFV in patients with grade I esophagitis. However, grade 2 and grade 3 esophagitis were associated more commonly with an abnormal GEFV (p < 0.00001, p < 0.02 respectively). Hiatal hernia is always associated with an abnormal GEFV. Abnormal GEFV correlated significantly with age (more frequent when older than 40 years). Sex, duration of symptoms (>3 years), response to medical therapy, smoking, and obesity (body mass index > 30 kg/m2) did not correlate significantly with abnormal GEFV. We conclude that endoscopic esophagitis is usually associated with abnormal GEFV. It is more frequent in grades 2 and 3 but not grade 1 esophagitis. It is also encountered more commonly after the age of 40 years.

Gastroesophageal flap valve is associated with gastroesophageal and gastropharyngeal reflux

“…Thus, grading of the GEFV is simple and reproducible, and offers additional useful information for the evaluation of patients with GERD. 6,9,22,23 In the present study, GERD, defined by ambulatory pH monitoring, was found in 35.7% of the normal GEFV group and in 67.3% of the abnormal GEFV group. Our results are similar to those in a previous report 9 that GERD, defined by the presence of abnormal esophageal acid exposure, was found in 33.0% of the normal GEFV group and in 66.7% of the abnormal GEFV group.…”

“…These findings are consistent with previous reports stating that abnormal GEFV is associated with reflux esophagitis and Barrett's epithelium. 9,22,23 In some prior reports, 22-24 a tendency for an agerelated increase in the prevalence of abnormal GFEV was noted; in another report, 9 there was no difference according to GEFV grade. We also did not observe an association of age with GEFV grade.…”

The Effect of Gastroesophageal Flap Valve Appearance on the Management of Patients with Symptoms of Gastroesophageal Reflux Disease

“…To our knowledge, only one previous study has correlated symptoms with grades of GEFV: Contractor et al found that patients with grades III and IV were more likely to have GERD symptoms, but response to medical therapy did not correlate with GEFV grades; however, a long-term on-demand treatment was not used [17].…”

A prospective study of the prevalence of gastroesophageal reflux disease and confounding factors

“…Based on these observations, Öberg et al 16 concluded that abnormal esophageal acid exposure and esophageal mucosal injury were uncommon in patients with grade 0 gastroesophageal valves, and these findings were therefore predictive of the absence of reflux disease. Contractor et al 17 reported that, the prevalence of abnormal GEFV function was significantly higher in patients with symptomatic gastroesophageal reflux without esophagitis compared with those patients with grade 1 esophagitis. Moreover, abnormal GEFV function was significantly more frequent in patients with grades 2 and 3 esophagitis (Savary-Miller classification) compared with the frequency in patients with grade 1.…”

“…There are two relevant reports on GEFV in non-Japanese. 16,17 In one, Öberg et al, 16 stated that the length of the LES was reduced and its function became more compromised in association with changes in GEFV grade; and during 24-h pH monitoring, the holding time at pH less than 4 increased in proportion to the GEFV grade. Based on these observations, Öberg et al 16 concluded that abnormal esophageal acid exposure and esophageal mucosal injury were uncommon in patients with grade 0 gastroesophageal valves, and these findings were therefore predictive of the absence of reflux disease.…”