Luo Xi, Guo Xiao-Xu, Wang Wei-Feng, Peng Li-Hua, Yang Yun-Sheng, Uedo Noriya
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.
World J Gastroenterol. 2016 Apr 14;22(14):3845-51. doi: 10.3748/wjg.v22.i14.3845.
To investigate whether autofluorescence imaging (AFI) endoscopy can distinguish non-erosive reflux disease (NERD) from functional heartburn (FH).
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.
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.
Autofluorescence imaging may serve as a complementary method in evaluating patients with NERD and FH.
探讨自体荧光成像（AFI）内镜检查能否区分非糜烂性反流病（NERD）和功能性烧心（FH）。
在这项前瞻性观察性试验中，对127例有典型反流症状超过6个月的患者进行了筛查。所有参与者均接受了内镜检查，检查过程中先进行白光成像（WLI），然后进行AFI。最终纳入84例WLI显示食管外观正常的患者。如果在AFI内镜检查过程中，食管远端可见一条或多条长度超过1厘米的纵向紫色线，则定义为提示NERD。还进行了动态24小时多通道腔内阻抗和pH监测。在标准质子泵抑制剂（PPI）试验后，将受试者分为NERD组和FH组，并评估AFI内镜检查区分NERD和FH的诊断性能。
在84例内镜检查阴性的患者中，36例（42.9%）pH/阻抗测试正常。其中，26例对PPI试验反应良好的患者被归类为患有NERD。最终，10例患者被诊断为FH，其余患者被诊断为NERD。总共84例患者中有68例（81.0%）AFI内镜检查呈阳性。在NERD组中，67例（90.5%）患者AFI内镜检查显示食管有异常表现，而在FH组中，只有1例（10%）患者AFI内镜检查呈阳性。AFI区分NERD和FH的敏感性和特异性分别为90.5%（95%CI：81.5%-96.1%）和90.0%（95%CI：55.5%-99.7%）。同时，AFI区分NERD和FH的准确性、阳性预测值和阴性预测值分别为90.5%（95%CI：84.2%-96.8%）、98.5%（95%CI：92.1%-99.9%）和56.3%（95%CI：30.0%-80.2%）。
自体荧光成像可作为评估NERD和FH患者的一种辅助方法。
