Prevalence of Minimal Change Lesions in Patients with Non-Erosive Reflux Disease: A Case-Control Study

Kim, Jin Bae; Shin, Su Rin; Shin, Woon Geon; Choi, Min Ho; Jang, Hyun Joo; Kim, Kyung Oh; Park, Cheol Hee; Baek, Il Hyun; Baik, Gwang Ho; Kim, Kyung Ho; Park, Sang Hoon; Kae, Sea Hyub; Lee, Myung Seok; Kim, Hak Yang

doi:10.1159/000337198

Cited by 15 publications

(15 citation statements)

References 31 publications

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“…In a case–control study, an irregular Z-line has been found with higher frequency in patients with reflux disease19 (Evidence grade IIa). Although one study found that about 40% of cases of irregular Z-line harboured IM on biopsy samples, the significance of this endoscopic finding is still unclear20 (Evidence grade III).…”

Section: Diagnosismentioning

confidence: 95%

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

1,167

1,297

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These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia. PURPOSE AND METHODSThe purpose of this guideline is to provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. This document is therefore aimed at gastroenterologists, physicians and nurse practitioners, as well as members of multidisciplinary teams (MDTs; surgeons, radiologists, pathologists), who take decisions on the management of such patients. The population covered by these guidelines includes: patients with gastrooesophageal reflux disease or other risk factors for Barrett's (obesity, family history for Barrett's and oesophageal adenocarcinoma (OAC)); every patient with incident or prevalent Barrett's oesophagus regardless of their age, sex or comorbidities; patients with early OAC and patients with intestinal metaplasia (IM) at the gastro-oesophageal junction (GOJ) with no endoscopic evidence of Barrett's oesophagus. The previous British Society of Gastroenterology (BSG) development of the guidelines and to aid assessment of the quality of the guidelines. Three appraisers in the author list assessed the compliance of the guidelines to the AGREE II domains. As part of the AGREE II criteria, external review of this manuscript was also performed by two internationally renowne...

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Section: Diagnosismentioning

confidence: 95%

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Fitzgerald

Pietro

Ragunath

et al. 2013

Gut

1,167

1,297

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“…Proposed minimal changes include: vascular changes at the SCJ (vascular spots above the Z-line, punctate erythema/shining of blood vessels through the mucosa, loss of long blood vessels above the Z-line, intraepithelial papillary capillary loop dilation or tortuosity), white mucosal turbidity at the SCJ, irregular Z-line, horizontal erosions, and triangular indentation into the squamous mucosa. 10,[15][16][17][18][19][20][21] Using pH monitoring as the standard, these minimal changes have a sensitivity for the assessment of NERD that ranges from 60% to 90%, and a specificity from 64% to 83%. Despite multiple studies and modalities for the diagnosis of minimal changes, there is no current consensus regarding the definition of "minimal changes.…”

Section: Minimal Changesmentioning

confidence: 99%

Identifying Minimal Changes in Nonerosive Reflux Disease

Gabbard

Fass

Maradey–Romero

et al. 2016

Journal of Clinical Gastroenterology

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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.

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“…[3][4][5] Furthermore, an irregular z line is more common in patients with reflux disease. 6 The second catch is noticing an area of columnar metaplasia in the proximal oesophagus and incorrectly labelling this as BE. This is actually a cervical inlet patch and is a developmental abnormality.…”

Section: Recognising What Is Not Be Endoscopic Diagnosismentioning

confidence: 99%

Monitoring the premalignant potential of Barrett's oesophagus'

Graham

Lipman

Sehgal

et al. 2016

Frontline Gastroenterol

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The landscape for patients with Barrett's oesophagus (BE) has changed significantly in the last decade. Research and new guidelines have helped gastroenterologists to better identify those patients with BE who are particularly at risk of developing oesophageal adenocarcinoma. In parallel, developments in endoscopic image enhancement technology and optical biopsy techniques have improved our ability to detect high-risk lesions. Once these lesions have been identified, the improvements in minimally invasive endoscopic therapies has meant that these patients can potentially be cured of early cancer and high-risk dysplastic lesions without the need for surgery, which still has a significant morbidity and mortality. The importance of reaching an accurate diagnosis of BE remains of paramount importance. More work is needed, however. The vast majority of those undergoing surveillance for their BE do not progress towards cancer and thus undergo a regular invasive procedure, which may impact on their psychological and physical well-being while incurring significant cost to the health service. New work that explores cheaper endoscopic or non-invasive ways to identify the at-risk individual provides exciting avenues for research. In future, the diagnosis and monitoring of patients with BE could move away from hospitals and into primary care.

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Prevalence of Minimal Change Lesions in Patients with Non-Erosive Reflux Disease: A Case-Control Study

Cited by 15 publications

References 31 publications

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

Identifying Minimal Changes in Nonerosive Reflux Disease

Monitoring the premalignant potential of Barrett's oesophagus'

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