Acid-suppressive therapy and narrow band imaging findings in GERD

The latest issue of the Diseases of the Esophagus investigates the effect of acid-suppressive therapy on narrow band imaging findings in gastroesophageal reflux disease.

Standard endoscopy is an insensitive test for gastroesophageal reflux disease (GERD).

Narrow band imaging endoscopy enhances visualization of the distal esophagus.

Narrow band imaging patterns like intrapapillary capillary loop dilatation, tortuosity, and increased number; microerosions; increased vascularity at the squamocolumnar junction; ridge-villous pattern below the squamocolumnar junction; and presence of columnar islands in the distal esophagus have been suggested as features of gastroesophageal reflux disease.

Dr Lynch and colleagues evaluated the effect of proton pump inhibitor therapy on narrow band imaging findings in gastroesophageal reflux disease patients.

The team of doctors noted that patients prospectively underwent narrow band imaging upper endoscopy before and after proton pump inhibitor therapy.

Narrow band imaging findings were recorded at each endoscopy.

The research team assessed that twenty-one patients with gastroesophageal reflux disease symptoms were studied.

After proton pump inhibitor therapy, there was a significant reduction in the proportion of patients with narrow band imaging features including intrapapillary capillary loop tortuosity, dilated intrapapillary capillary loops, and increased vascularity at the squamocolumnar junction.

PPIs led to healing of all microerosions

Diseases of the Esophagus

The doctors found that proton pump inhibitors led to healing of all microerosions and disappearance of ridge-villous patterns below the squamocolumnar junction.

There was no significant change in the proportion of patients with increased numbers of intrapapillary capillary loops pre- and post-proton pump inhibitor therapy or columnar islands in the distal esophagus.

Dr Lynch's team commented, "In patients with gastroesophageal reflux disease  symptoms, narrow band imaging features suggestive of gastroesophageal reflux disease respond to proton pump inhibitor."

"This suggests that these features are truly acid-mediated."

"These findings need to be confirmed by randomized controlled trials."