Indiana University School of Medicine Indianapolis, IN
Nour Hamade, MD1, Jean Chalhoub, MD2, Hala Fatima, MD1, Prateek Sharma, MD, FACG3; 1Indiana University School of Medicine, Indianapolis, IN; 2Baystate Medical Center, Springfield, MA; 3Kansas City VA Medical Center, Kansas City, MO
Introduction: Most patients with typical reflux symptoms have no evidence of erosive esophagitis on white light endoscopy (WLE). Narrow band imaging (NBI) enhances visualization of the microvasculature and mucosal patterns and has been shown in a few, small studies to identify features associated with non-erosive reflux disease (NERD) not seen during WLE. Our aim was to conduct a systematic review and meta-analysis to evaluate the utility of NBI in patients with NERD. Methods: We conducted a search in PubMed, MedLine (OVID), and Google Scholar to identify papers that reported on NBI findings in patients with NERD and controls (subjects without reflux symptoms). Case series, case reports, editorials, and review articles were excluded. We collected data on the following findings in NERD patients and controls: presence of microerosions, increased vascularity, increased intrapapillary capillary loops (IPCLs), dilated IPCL and presence of round pit pattern at the gastroesophageal junction (GEJ). The primary outcome of the study was to evaluate the diagnostic characteristics of NBI in patients with NERD. Random-effects model was used and odds ratio (OR) with 95% confidence intervals (CI) were evaluated for the analyses of all outcomes. In addition, the sensitivity and specificity of each endoscopic NBI finding was also estimated. Results: A total of 5 studies were included in the final analysis: 397 subjects: NERD n=127 and controls n=159 (Table 1). Compared to controls, NERD patients had almost 8.5 times higher odds of having microerosions [OR 8.47; 95%CI (3.29-21.78) I2 16%] and 7.8 times higher odds of having increased vascularity [OR 7.80; 95%CI (3.44-17.66) I2 0%](Figure 1). Additionally, patients with NERD had significantly higher odds of having increased number of IPCL [OR 8.44; 95%CI (3.49-20.43) I2 38%] and dilated IPCL [OR 6.93; 95%CI (1.01-47.81) I2 81%] compared to controls. Conversely, patients with NERD had 20 times lower odds of having a round pit pattern at the GEJ compared to controls [OR 0.05; 95%CI (0.02-0.12) I2 0%]. The sensitivity of the NBI findings in NERD patients ranged from 39.37% to 61.54% and specificity ranged from 83.19% to 93.71% (Table 2). Discussion: NBI examination of the lower esophagus reveals findings that are quite distinct in patients with NERD compared to controls. NERD patients have significantly higher odds of microerosions, increased and dilated capillary loops compared to controls. NBI may be a simple clinical technique to appropriately characterize NERD patients.
Table 1: Characteristics of Included Studies
Table 2: Sensitivity and Specificity of NBI findings in patients with NERD compared to controls (without reflux)
Figure 1: Forest plot comparing presence of microerosions in NERD vs control
Disclosures: Nour Hamade indicated no relevant financial relationships. Jean Chalhoub indicated no relevant financial relationships. Hala Fatima indicated no relevant financial relationships. Prateek Sharma indicated no relevant financial relationships.