title: The clinical usefulness of the ZAP classification for non-erosive reflux disease (NERD), using distal esophageal biopsy.
abstract: 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.
authors: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
authors: Beom Jin
authors: BJ
authors: Kim
authors: Poong-Lyul
authors: PL
authors: Rheez
authors: Hyuk
authors: H
authors: Lee
authors: Jeong Hwan
authors: JH
authors: Kim
authors: Hee Jung
authors: HJ
authors: Son
authors: Dong Kyung
authors: DK
authors: Chang
authors: Young-Ho
authors: YH
authors: Kim
authors: Jae J
authors: JJ
authors: Kim
authors: Jong Chul
authors: JC
authors: Rhee
authors: Ji Hoon
authors: JH
authors: Kim
mesh_terms: 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