Identifying Minimal Changes in Nonerosive Reflux Disease

Abstract

Gastroesophageal reflux disease has a variable presentation on upper endoscopy. Gastroesophageal reflux disease can be divided into 3 endoscopic categories: Barrett's esophagus, erosive esophagitis, and normal mucosa/nonerosive reflux disease (NERD). Each of these phenotypes behave in a distinct manner, in regards to symptom response to treatment, and risk of development of complications such as esophageal adenocarcinoma. Recently, it has been proposed to further differentiate NERD into 2 categories: those with and those without "minimal changes." These minimal changes include endoscopic abnormalities, such as villous mucosal surface, mucosal islands, microerosions, and increased vascularity at the squamocolumnar junction. Although some studies have shown that patients with minimal changes may have higher rates of esophageal acid exposure compared with those without minimal changes, it is currently unclear if these patients behave differently than those currently categorized as having NERD. The clinical utility of identifying these lesions should be weighed against the cost of the requisite equipment and the additional time required for diagnosis, compared with conventional white light endoscopy.

Screening of endoscopic microerosions in non-erosive esophagitis by high-definition digestive endoscopy coupled with narrow-band imaging and microerosions analysis by immunohistochemical, pHmetric and histology

“…pHmetry or 24-hour impedance-pHmetry). The minimal endoscopic alterations do not seem to predict which patients would be at higher risk of progression to adenocarcinoma, nor would they predict a clinical or surgical response in GERD [37].…”

Narrowed-spectrum Technologies in Endoscopic Imaging of The Upper Gastrointestinal Tract

“…7 A consistent limitation of these endoscopic studies is the use of GERD symptom questionnaires for patient identification, rather than objective acid exposure. In fact, the response to proton-pump inhibitor therapy in so-called minimal change esophagitis has been estimated to be as low as 39% 8 and some studies have suggested no difference in esophageal acid exposure between minimal change and non-erosive GERD. 9…”

Clinical significance of gastroesophageal reflux disease with minimal change: a multicenter prospective observational study

“…In Japan, LA classification grade M (minimal change) has been introduced 6 . Several studies have investigated the differences among LA grades M, N, and A in terms of histology, acid exposure time, and esophageal motility dysfunction [7][8][9][10][11] . However, the clinical significance of classification of NERD into LA grades N and M remains unknown.…”