Evaluation of gastro‐oesophageal flap valve is useful for diagnosing gastro‐oesophageal reflux disease

Abstract

Summary Background Gastro‐oesophageal flap valve (GEFV) grade correlated with endoscopic reflux oesophagitis (RE) prevalence. Aim To investigate relationships among gastro‐oesophageal reflux disease (GERD) symptoms, RE and/or non‐erosive reflux disease (NERD) and GEFV grades in subjects undergoing endoscopy. Methods We enrolled 1305 subjects from whom endoscopic results and the results of a self‐administered questionnaire (QUEST) were available. Subjects were evaluated for GERD symptoms (QUEST score), GEFV grade, RE and gastric mucosal atrophy. Results Total GERD prevalence, including symptomatic GERD (QUEST score ≥ 4) and/or RE, was 27%. RE grade and prevalence increased with GEFV grade. QUEST scores and GEFV grades showed a positive correlation. NERD prevalence was 14% and increased with GEFV grade, but the relationship was weaker than that between RE and GEFV. Comparing RE‐negative subjects by GEFV grade, GERD symptoms were noted in 10%, 19%, 36% and 52% with GEFV grades I, II, III and IV, respectively. Neither type of gastric mucosal atrophy correlated with GEFV grade. Conclusions Total GERD, NERD and RE prevalences increased with GEFV grade. Subjects with high GEFV grades often complain of GERD symptoms, even without RE. Our findings suggest that endoscopic GEFV evaluation provides a useful clinical index for diagnosing GERD.

Abnormal Gastroesophageal Flap Valve Is Associated With High Gastresophageal Reflux Disease Questionnaire Score and the Severity of Gastroesophageal Reflux Disease in Vietnamese Patients With Upper Gastrointestinal Symptoms

“…There were very few Asian data about the prevalence of abnormal GEFV. Iwamoto et al 7 reported that the prevalence of abnormal GEFV in Japan was 13.5% with a total GERD prevalence of 27.0% among patients undergoing endoscopic examination. In another study in Taiwan, Lin et al 6 reported that the prevalence of ab-normal GEFV was 27.3% with a total GERD prevalence of 41.3% among subjects undergoing routine check-ups.…”

“…The association between GEFV and gastroesophageal reflux disease (GERD) has been already reported in several previous studies. [2][3][4][5][6][7] However, most of these studies were conducted on patients with reflux esophagitis (RE) [2][3][4][5] and there were very few studies on patients with dyspepsia and non-erosive reflux disease (NERD). 6,7 There have been no studies investigating the distribution of abnormal GEFV among patients with dyspepsia, NERD and different grades of RE in the same set of patients.…”

“…A previous study reported that the scores of quality of life and utility evaluation survey technology (QUEST) questionnaire had a positive correlation with GEFV grades. 7 But a recent study showed that this questionnaire was complicated to complete. 8 The gastroesophageal reflux disease questionnaire (GERDQ) has been developed as a useful tool to improve and standardize symptom-based diagnosis in patients with GERD.…”

Barrett's esophagus and endoscopically assessed esophagogastric junction integrity in 1000 consecutive Turkish patients undergoing endoscopy: a prospective study

“…The GEFV grading system defines anatomical distortions that are milder than obvious HH 4 . Validation studies of this grading system have shown that abnormal GEFV findings are associated with the presence of GERD symptoms, 6 the presence of abnormal acid exposure, 38,39 the degree of exercise‐induced reflux, 4 the presence and severity of EE, 5,6,38–42 and the risk of newly developing EE after Helicobacter pylori eradication 5,43 . Three of these studies have also shown an association between abnormal GEFV findings and the prevalence of BE, 38–40 but biopsy confirmation of BE was done in only one of these studies 39 …”

“… 3 is used as an endoscopic descriptor of anatomical integrity of the EGJ. Although this grading system parameterizes aberrations that are more subtle than obvious hiatal hernia (HH), HH is frequently detected in patients with grade 3 flap valves as well as in patients with grade 4 flap valves, HH being always present in the latter group 4–6 . Hill's grading system not only involves a description of the musculo‐mucosal fold, but it also grades the stepwise relaxation of the EGJ 3,4 .…”