title: High-definition endoscopy with iScan and Lugol's solution for the detection of inflammation in patients with nonerosive reflux disease: histologic evaluation in comparison with a control group.
abstract: Nonerosive reflux disease (NERD) is commonly diagnosed in patients with symptoms of reflux. The aim of the present study was to determine whether high-definition endoscopy (HD) plus equipped with the iScan function or chromoendoscopy with Lugol's solution might permit the differentiation of NERD patients from those without reflux symptoms, proven by targeted biopsies of endoscopic lesions. A total of 100 patients without regular intake of proton pump inhibitors and with a normal conventional upper endoscopy were prospectively divided into NERD patients and controls. A second upper endoscopy was performed using HD+ with additional iScan function and then Lugol's solution was applied. Biopsy specimens were taken from the gastroesophageal junction in all patients. A total of 65 patients with reflux symptoms and 27 controls were included. HD(+) endoscopy with iScan revealed subtle mucosal breaks in 52 patients; the subsequent biopsies confirmed esophagitis in all cases. After Lugol's solution, 58 patients showed mucosal breaks. Sensitivity for the iScan procedure was 82.5%, whereas that for Lugol's solution was 92.06%. Excellent positive predictive values of 100% and 98.3%, respectively, were noted. The present study suggests that the majority of patients with NERD and typical symptoms of reflux disease can be identified by iScan or Lugol's chromoendoscopy as minimal erosive reﬂux disease (ERD) patients.
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.|Department of Internal Medicine II, HSK Hospital, Wiesbaden, Germany.
authors.forename: J W
authors.initials: JW
authors.lastname: Rey
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Deris
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.
authors.forename: J U
authors.initials: JU
authors.lastname: Marquardt
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Thomaidis
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Moehler
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.
authors.forename: J M
authors.initials: JM
authors.lastname: Kittner
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Nguyen-Tat
authors.affiliation: Max Planck Institute for Plant Breeding Research Cologne, Cologne, Germany.|Institute for Genetics, University of Cologne, Cologne, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Dümcke
authors.affiliation: Max Planck Institute for Plant Breeding Research Cologne, Cologne, Germany.|Institute for Genetics, University of Cologne, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Tresch
authors.affiliation: Institute for Pathology, University Hospital, Düsseldorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Biesterfeld
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.|First Department of Internal Medicine, University Hospital, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Goetz
authors.affiliation: First Department of Internal Medicine, University Hospital, Erlangen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Mudter
authors.affiliation: First Department of Internal Medicine, University Hospital, Erlangen, Germany.
authors.forename: M F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.
authors.forename: P R
authors.initials: PR
authors.lastname: Galle
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.|Department of Internal Medicine II, HSK Hospital, Wiesbaden, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kiesslich
authors.affiliation: First Department of Internal Medicine, University Medical Center, Mainz, Germany.|Department of Internal Medicine II, HSK Hospital, Wiesbaden, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hoffman
mesh_terms: D016022:Case-Control Studies; D003937:Diagnosis, Differential; D000071041:Esophageal Mucosa / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging*; D007454:Iodides; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D007454:Iodides; C010389:Lugol's solution
keywords: Barrett's esophagus; Lugol's solution; endoscopic biopsy; erosive gastroesophageal reflux disease; high-definition endoscopy; nonerosive gastroesophageal reflux disease