Minimal endoscopic changes in non-erosive reflux disease

Area of Science:

• Gastroenterology
• Endoscopy
• Histopathology

Background:

• Gastroesophageal reflux disease (GERD) is a prevalent global condition with significant economic burden.
• A substantial proportion of GERD patients exhibit no visible erosions during esophagogastroduodenoscopy (EGD), complicating diagnosis.
• Non-erosive reflux disease (NERD) presents diagnostic challenges without further investigation.

Purpose of the Study:

• To assess the correlation between subtle endoscopic findings (carditis, mucosal thickening, vessel invisibility) and histological changes in distal esophageal biopsies.
• To evaluate the diagnostic specificity of GERD symptoms for non-erosive reflux disease.
• To investigate associations between endoscopic findings, patient characteristics, and GERD severity.

Main Methods:

• Retrospective cross-sectional study utilizing a Brazilian hospital's digital database (March-October 2012).
• Inclusion of non-smoking adult patients (>18 years) with GERD symptoms but no EGD-visible erosions, who underwent EGD and biopsy.
• Analysis of minimal endoscopic changes and correlation with distal esophageal biopsy results.

Main Results:

• The study included 23 patients, with vessel invisibility (91.3%), mucosal thickening (65.2%), and carditis (21.7%) being the most frequent endoscopic findings.
• Mucosal thickening demonstrated a moderate correlation (0.479) with anatomopathological diagnosis.
• Increased body mass index (0.386) and hiatal hernia (0.462) were also associated with study outcomes.

Conclusions:

• All patients with GERD symptoms and no erosions showed minimal endoscopic alterations.
• Mucosal thickening on EGD moderately correlated with esophagitis severity in NERD patients.
• Elevated body mass index and hiatal hernia presence are associated factors in GERD patients with minimal endoscopic changes.