[The application of high-resolution endoscopy in non-erosive reflux disease]

To establish the diagnosis standards of the non-erosive reflux disease (NERD) using high-resolution endoscopy. The diagnostic standards are established by observing the evolution of main endoscopic appearance of NERD with high-resolution endoscopy, in conjunction with 24 h monitoring of the pH and proton-pump inhibitor experiments.

Patients with gastroesophageal reflux disease symptoms and healthy volunteers were enrolled. All the individuals were assessed with high-resolution endoscopy and 24 h ambulatory pH monitoring. Patients with negative 24 h ambulatory pH monitoring or with positive 24 h ambulatory pH monitoring but negative endoscopic appearance were undertaken proton-pump inhibitor test.

The individuals were divided into 3 groups: 19 in erosive esophagitis, 62 in non-erosive group, and 24 were healthy volunteers. The shapes of Z-lines are divided into 6 types: sharply circle, sparsely serration, serration, tattered, triangular extension and lingulate extension. The percentage of each type in non-erosive group was 6.5%, 6.5%, 6.5%, 11.2%, 61.2%, and 8.1% respectively. The percentage of sharply circle, sparsely serration and triangular extension Z-lines were 25.0%, 58.3% and 16.7% respectively in the control group. There were more serration, fractured, triangular extension, and tongue-like extension Z-lines in the non-erosive group than in the control group. The difference was significant (P < 0.05). The appearance of the cardia membrane below the Z-line was categorized into four types: flatted, rough, concavo-convex and villiform. In the control group, the percentage of flatted, rough and concavo-convex types were 16.6%, 54.2%, and 29.2% respectively. In the non-erosive group, cardia membrane of rough, concavo-convex and villiform shapes were 16.1%, 9.7%, and 74.2% respectively. There were more shapes of villiform types in the non-erosive group than in the control group. The difference was significant (P < 0.05). The sensitivity and specificity of high resolution endoscopic test in diagnosing NERD was 77.8% and 6/8 respectively.

High resolution endoscopic test will raise the diagnostic rate of NERD. NERD was divided into non-erosive esophagitis and symptomatic gastroesophageal reflux disease.