Minimal changes, such as erythema without sharp demarcation or whitish turbidity of the lower esophageal mucosa, have recently been used for endoscopic classification of nonerosive reflux disease in Japan.
Dr Takashi Joh and colleagues from Japan examined the usefulness of such changes in characterizing the pathophysiology of nonerosive reflux disease.
|57% of grade M patients had pH under 4 more than 4% of the time|
|Journal of Gastroenterology|
Physicians specializing in esophageal endoscopy performed endoscopy on 115 patients with nonerosive reflux disease.
Based on the presence or absence of minimal changes, 49 patients were categorized as Grade M, displaying nonerosive reflux disease with minimal changes.
A further 66 patients were categorized as Grade N, and had no minimal changes or mucosal breaks.
Clinical features, quality of life scores, and ambulatory 24-hour esophageal pH values were compared between groups.
Ambulatory 24-hour esophageal pH values were monitored in 31 patients who gave consent out of 115 patients.
The researchers found in ambulatory 24-hour esophageal pH monitoring, that 57% of grade M patients had pH under 4 more than 4% of the time.
The team noted that in the Grade N group, 12% had pH under 4 more than 4% of the time.
Quality of life scores did not differ significantly between grades, and were significantly lower in both groups compared with the general Japanese population.
The team observed no significant differences in patient background between the grade M and grade N groups.
Dr Joh's team concluded, "Frequency of abnormal acid reflux with nonerosive reflux disease is higher in patients with minimal changes than in patients without such changes."
"Minimal changes are most likely attributable to gastric acid reflux."