Original articleClinical endoscopyNarrow-band imaging for the diagnosis of nonerosive reflux disease: an international, multicenter, randomized controlled trial
Section snippets
Patients and eligibility
This was a randomized controlled trial conducted at 2 academic tertiary care sites: Kansas City Veteran’s Affairs Medical Center (Kansas City, Mo, USA) and Nottingham University Hospital (Nottingham, UK). Patients aged 18 to 80 years who were referred for EGD for any indication were screened for eligibility. Subjects with a history of significant comorbidities (oxygen-dependent chronic obstructive pulmonary disease, severe congestive heart failure, recent diagnosis of cancer with a life
Baseline characteristics
At both sites, 122 patients satisfied the inclusion criteria and completed the GERDQ (Fig. 1). After an upper endoscopy, 27 patients were excluded because of erosive esophagitis and 5 after an alternate diagnosis or withdrawal of consent. Of the 90 remaining patients who underwent NBI evaluation and pH monitoring, 47 patients were excluded because of withdrawal of consent for various reasons (55%) or failure to maintain acid suppression therapy (45%). Finally, there were 21 NERD and 21 control
Discussion
In a prospective, multicenter, randomized trial, we found that mucosal changes not seen with white light but detected by NBI could be used as surrogate markers for a NERD diagnosis. Absence of RVPs, microerosions, and IPCL tortuosity could exclude a NERD diagnosis with 90% certainty. The presence of these 3 features can reliably diagnose ∼75% of NERD subjects. In addition, RVP correlated well with acid exposure time and resolved after PPI therapy in all subjects, making it a single measure that
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DISCLOSURE: The following authors disclosed financial relationships: K. Ragunath: Consultant for Olympus and Boston Scientific. P. Sharma: Consultant for Medtronic, Olympus, Boston Scientific, Fujifilm, Salix Pharmaceuticals, and Lumendi; grant support from Ironwood, Erbe, Docbot, Cosmo Pharmaceuticals, and CDX Labs. M. Desai: Grant support from Intercept Pharma. All other authors disclosed no financial relationships.
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Drs Ragunath and Sharma contributed equally to this article.