Interobserver agreement on classifying endoscopic diagnoses of nonerosive esophagitis

Amano, Yuji; Ishimura, Norihisa; Furuta, K.; Okita, Koichi; Masaharu, M.; Azumi, Takane; Ose, Turid; Koshino, Kenji; Ishihara, Shunji; Adachi, Kai; Kinoshita, Yoshikazu

doi:10.1055/s-2006-944778

Cited by 47 publications

(46 citation statements)

References 6 publications

(7 reference statements)

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“…Each patient had the esophagus examined for at least 1 minute using CVE and immediately thereafter using FICE (Fujinon EPX-4400) for a further 1 minute or more. Channel 4 was selected because it is generally deemed the best wavelength for this assessment (1,3) . The length and circumference of lesions were measured both with and without FICE.…”

Section: Methodsmentioning

confidence: 99%

A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE)

Gomes

Loução

Carpi

et al. 2011

Arq. Gastroenterol.

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-Context -Gastroesophageal reflux disease is very prevalent in the world. Endoscopically it can be classified as nonerosive when there is no mucosal erosive lesion on endoscopy. The presence of endoscopic minimal lesions is included in the Los Angeles classification for reflux disease. Virtual chromoendoscopy Fuji Intelligent Color Enhancement (FICE) is an endoscopic technique that enhances detection of small lesions of the digestive tract. Objective -To evaluate whether the use of FICE improves the diagnosis of minimal lesions on endoscopy, and to assess the association of symptoms with minimal lesions in patients with nonerosive reflux disease. Methods -One hundred fiftyfive patients were enrolled, 62 with typical reflux symptoms and 93 without esophageal symptoms. The patients had normal esophageal endoscopy or minimal lesions. Each patient was examined initially by conventional video endoscopy and then using FICE. Results -Among 155 patients, 113 had a normal conventional endoscopy and 42 had minimal lesions. Sixty-two patients had typical reflux symptoms, and 93 other symptoms unrelated to reflux. In 104 patients, the esophageal mucosa was normal for both conventional endoscopy and FICE, in 42 patients both techniques showed minimal lesions, in 9 patients conventional endoscopy was normal and minimal lesions were shown by FICE. The height and circumference of minimal lesions were greater using FICE than that measured by conventional endoscopy. There was a significant association of the presence of minimal lesions with male gender, but not with alcoholism, smoking, anti-inflammatory drugs and age. The diagnosis of minimal lesions was observer-dependent, both in conventional endoscopy as using FICE. ConclusionsThe use of FICE improves the diagnosis of minimal lesions as compared to conventional videoendoscopy, although this diagnosis remains observer-dependent. There was no association between the presences of minimal lesions with reflux symptoms.

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Section: Methodsmentioning

confidence: 99%

A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE)

Gomes

Loução

Carpi

et al. 2011

Arq. Gastroenterol.

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“…Grade M is defined as minimal changes to the esophageal mucosa, such as reddish erythema and/or whitish turbidity [12]. Although the definition of reflux esophagitis depends on the individual study, GERD defined as LA classification grade A or more, termed ''erosive esophagitis,'' could exclude interobserver bias because of the extremely poor agreement in the endoscopic diagnosis of grade M [14,15].…”

Section: Terminology Used In Gerd Diagnosismentioning

confidence: 99%

“…Because interobserver agreement on grade M is extremely poor, [14,15] and because the two large studies [29,30] combined cases of grade C and grade D, and because the LA classification for grade C and grade D was revised in 1999, [60] we analyzed the severity of erosive esophagitis as grade A, grade B, and grade C ? D. A total of 9782 cases with erosive esophagitis were analyzed.…”

Section: Terminology Used In Gerd Diagnosismentioning

confidence: 99%

Epidemiology and clinical characteristics of GERD in the Japanese population

2009

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We reviewed articles on the epidemiology and clinical characteristics of gastroesophageal reflux disease (GERD) in Japan to clarify these features of GERD in this country. Although the definition of GERD depends on the individual study, the prevalence of GERD has been increasing since the end of the 1990s. The reasons for the increase in the prevalence of GERD may be due to increases in gastric acid secretion, a decrease in the Helicobacter pylori infection rate, more attention being paid to GERD, and advances in the concept of GERD. More than half of GERD patients had non-erosive reflux disease, and the majority (87%) of erosive esophagitis was mild type, such as Los Angeles classification grade A and grade B. There were several identified risk factors, such as older age, obesity, and hiatal hernia. In particular, mild gastric atrophy and absence of H. pylori infection influence the characteristics of GERD in the Japanese population. We also discuss GERD in the elderly; asymptomatic GERD; the natural history of GERD; and associations between GERD and peptic ulcer disease and H. pylori eradication. We examined the prevalence of GERD in patients with specific diseases, and found a higher prevalence of GERD, compared with that in the general population, in patients with diabetes mellitus, those with obstructive sleep apnea syndrome, and those with bronchial asthma. We provide a comprehensive review of GERD in the Japanese population and raise several clinical issues.

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“…Reflux esophagitis was diagnosed and graded according to the Los Angeles classification (grade A-D) (16). This study excluded grade M (minimal change) because of low interobserver and intraobserver agreements (17). Hiatal hernia was defined as an apparent separation of the esophagogastric junction and diaphragm impression by more than 2 cm at endoscopy.…”

Section: Endoscopic Assessmentmentioning

confidence: 99%

A Multicenter Study on the Prevalence of Eosinophilic Esophagitis and PPI-Responsive Esophageal Eosinophilic Infiltration

et al. 2012

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Objective Eosinophilic esophagitis (EoE) is diagnosed by the presence of dysphagia and intraepithelial eosinophilic infiltration of ! 15 per high-power field (HPF). EoE should be distinguished from proton pump inhibitor-responsive esophageal eosinophilic infiltration (PPI-R EEI) in patients that are responsive to PPI treatment. The aim of this study was to determine the prevalence of EoE and PPI-R EEI in Japanese patients in a multicenter study. Methods Ten hospitals participated in this study. Esophageal biopsy was performed when the patients had typical EoE symptoms or when endoscopic findings revealed a typical EoE appearance. EEI was defined as the intraepithelial eosinophilic infiltration of ! 15 per HPF. Patients with EEI received rabeprazole for 8 weeks to distinguish EoE from PPI-R EEI. Results A total of 13,634 subjects that underwent upper gastrointestinal endoscopy because of further examination or as a routine checkup were enrolled. Seventy-one (0.5%) patients suspected with EoE were examined by biopsy. A histological examination of 7 (9.9%) cases revealed EEI. Two of these 7 patients showed no symptoms and the other 5 were treated with PPI. Two (0.01%) patients were diagnosed with EoE and 3 (0.02%) with PPI-R EEI. Conclusion EoE and PPI-R EEI were rare in Japanese patients that underwent upper gastrointestinal endoscopy.

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Interobserver agreement on classifying endoscopic diagnoses of nonerosive esophagitis

Abstract: Interobserver agreement on the endoscopic diagnosis of nonerosive esophagitis (grades M and N) is too low to be of clinical value.

Cited by 47 publications

References 6 publications

A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE)

A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE)

Epidemiology and clinical characteristics of GERD in the Japanese population

A Multicenter Study on the Prevalence of Eosinophilic Esophagitis and PPI-Responsive Esophageal Eosinophilic Infiltration

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