title: Autofluorescence imaging endoscopy can distinguish non-erosive reflux disease from functional heartburn: A pilot study.
abstract: OBJECTIVE
  To investigate whether autofluorescence imaging (AFI) endoscopy can distinguish non-erosive reflux disease (NERD) from functional heartburn (FH).
  
  
  METHODS
  In this prospective observational trial, 127 patients presenting with typical reflux symptoms for > 6 mo were screened. All the participants underwent endoscopy, during which white light imaging (WLI) was followed by AFI. Finally 84 patients with normal esophageal appearance on WLI were enrolled. It was defined as being suggestive of NERD if one or more longitudinal purple lines longer than one centimeter were visualized in the distal part of the esophagus during AFI endoscopy. Ambulatory 24-h multichannel intraluminal impedance and pH monitoring was also performed. After standard proton-pump inhibitor (PPI) tests, subjects were divided into an NERD group and an FH group and the diagnostic performance of AFI endoscopy to differentiate NERD from FH was evaluated.
  
  
  RESULTS
  Of 84 endoscopy-negative patients, 36 (42.9%) had a normal pH/impedance test. Of these, 26 patients with favorable responses to PPI tests were classified as having NERD. Finally 10 patients were diagnosed with FH and the others with NERD. Altogether, 68 (81.0%) of the 84 patients were positive on AFI endoscopy. In the NERD group, there were 67 (90.5%) patients with abnormal esophageal findings on AFI endoscopy while only 1 (10%) patient was positive on AFI endoscopy in the FH group. The sensitivity and specificity of AFI in differentiating NERD from FH were 90.5% (95%CI: 81.5%-96.1%) and 90.0% (95%CI: 55.5%-99.7%), respectively. Meanwhile, the accuracy, positive predictive value and negative predictive value of AFI in differentiating between NERD and FH were 90.5% (95%CI: 84.2%-96.8%), 98.5% (95%CI: 92.1%-99.9%) and 56.3% (95%CI: 30.0%-80.2%), respectively.
  
  
  CONCLUSIONS
  Autofluorescence imaging may serve as a complementary method in evaluating patients with NERD and FH.
authors.affiliation: Xi Luo, Xiao-Xu Guo, Wei-Feng Wang, Li-Hua Peng, Yun-Sheng Yang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Luo
authors.affiliation: Xi Luo, Xiao-Xu Guo, Wei-Feng Wang, Li-Hua Peng, Yun-Sheng Yang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Xiao-Xu
authors.initials: XX
authors.lastname: Guo
authors.affiliation: Xi Luo, Xiao-Xu Guo, Wei-Feng Wang, Li-Hua Peng, Yun-Sheng Yang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Wang
authors.affiliation: Xi Luo, Xiao-Xu Guo, Wei-Feng Wang, Li-Hua Peng, Yun-Sheng Yang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Peng
authors.affiliation: Xi Luo, Xiao-Xu Guo, Wei-Feng Wang, Li-Hua Peng, Yun-Sheng Yang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Yun-Sheng
authors.initials: YS
authors.lastname: Yang
authors.affiliation: Xi Luo, Xiao-Xu Guo, Wei-Feng Wang, Li-Hua Peng, Yun-Sheng Yang, Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006356:Heartburn / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies
keywords: Ambulatory 24-h pH/impedance monitoring; Autofluorescence imaging; Endoscopy; Esophagitis; Functional heartburn; Gastroesophageal reflux disease; Non-erosive reflux disease; White light imaging