The clinical usefulness of the ZAP classification for non-erosive reflux disease (NERD), using distal esophageal biopsy.
OBJECTIVE
It has been reported that the Z-line appearance (the ZAP grade) wascorrelated with the prevalence of intestinal metaplasia. Therefore, we prospectively investigated the clinical usefulness of ZAP classification based on the histology in making a diagnosis of non-erosive reflux disease (NERD).


METHODS
We studied 80 consecutive young male patients with heartburn and acid regurgitation. The symptom characteristics were collected by interviewing with a structured questionnaire. Upper GI endoscopy with biopsy was performed to identify the distal esophagitis.


RESULTS
Correlation was significant between the ZAP score and the LA classification (Spearman cor relation factor: 0.463). There were no significant differences in symptom according to the ZAP score. There were no significant differences in microscopic esophagitis between the patients with NERD (ZAP 0) and those with ERD (Erosive Reflux Disease, ZAP I, II, III). No statistical significance was observed between the ZAP score and the histology. In the diagnosis of NERD, ZAP classificationwas more accurate than LA classification in the basis of histology at distal esophagus (p < 0.05).


CONCLUSIONS
The ZAP classification could be applied to diagnosis of GERD, especially NERD. Biopsy taken at distal esophagus can be a limited but useful diagnostic tool, particularly in patients with NERD.
Kim
Beom Jin
BJ
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
Rheez
Poong-Lyul
PL
Lee
Hyuk
H
Kim
Jeong Hwan
JH
Son
Hee Jung
HJ
Chang
Dong Kyung
DK
Kim
Young-Ho
YH
Kim
Jae J
JJ
Rhee
Jong Chul
JC
Kim
Ji Hoon
JH
D001706:Biopsy; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000473:pathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult