Relationship Between Gastroesophageal Reflux Disease and Endoscopic Finding "Iodine-Unstained Streak".
Relationship Between Gastroesophageal Reflux Disease and Endoscopic Finding "Iodine-Unstained Streak".
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DOI：
10.14740/jocmr4331
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发表时间：
2020-11
期刊：
影响因子：
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通讯作者：
Okuro M
中科院分区：
文献类型：
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作者：
Hamada K;Itoh T;Kawaura K;Kitakata H;Kuno H;Kamai J;Kobayasi R;Azukisawa S;Ishisaka T;Igarashi Y;Kodera K;Okuno T;Morita T;Himeno T;Yano H;Higashikawa T;Iritani O;Iwai K;Morimoto S;Okuro M
碘染色食管胃管镜检查是诊断食管癌的一种有效而广泛的方法。我们可以很容易地进行手术与内窥镜系统，不包括图像增强内窥镜。一些研究认为，碘未染色条纹是胃食管反流病（GERD）的特征性发现。然而，关于这一主题的报道很少。在这项研究中，我们调查的有用性碘色素内镜GERD咨询。该研究对154例GERD病例进行了食管碘染色EGD。对154例食管反流性食管炎及食管内碘不染条纹的存在情况进行分析。在EGD后开始用药的47例GERD病例中（质子泵抑制剂（PPI）：45例，组胺H2受体拮抗剂（H2-RA）：2例），我们检查了症状改善的预测因素，如性别、年龄、体重、反流性食管炎发现和碘未染色条纹。在50/154例（32.5%）病例中观察到碘未染色条纹。在50例有碘未染色条纹的病例中，只有24/50例（48.0%）既有反流性食管炎结果（≥洛杉矶分级：M级）又有碘未染色条纹。在开始用药的47例病例中，34例病例的症状有所改善，13例病例未显示改善。“好转”组较“未好转”组多见碘不染条纹（P < 0.01）。以胃食管反流病患者胃粘膜碘不染条纹作为药物疗效的预测指标，敏感性为61.8%，特异性为84.6%。无反流性食管炎的GERD患者多无糜烂，“好转”组较“未好转”组多见碘不染条纹。我们认为，碘不染条纹可作为GERD的诊断及药物疗效的预测指标。
Esophagogastroduodenoscopy (EGD) with iodine stain is a useful and diffused method for diagnosing esophageal cancer. We can perform the procedure easily with endoscopic system which does not comprise image-enhanced endoscopy. Several studies advocated that iodine-unstained streaks are a characteristic finding of gastroesophageal reflux disease (GERD). However, there are only a few reports about the subject. In this study, we investigated the usefulness of iodine chromoendoscopy for GERD consultation. The study was conducted with 154 GERD cases in which EGD with iodine stain to the esophagus was performed. For the 154 cases, we analyzed the existence of reflux esophagitis finding and iodine-unstained streaks. In 47 GERD cases (proton pump inhibitor (PPI): 45 cases, histamine H2-receptor antagonist (H2-RA): two cases) where medication was started after EGD, we examined predictive factors of the symptom improvement such as sex, age, weight, reflux esophagitis finding, and iodine-unstained streak. An iodine-unstained streak was observed in 50/154 cases (32.5%). For 50 cases with iodine-unstained streak, there were only 24/50 cases (48.0%) that had both reflux esophagitis findings (≥ Los Angeles classification: grade M) and an iodine-unstained streak. For 47 cases in which medication was started, 34 cases showed improvement in their symptoms, and 13 cases did not show improvement. An iodine-unstained streak was observed more often in “Improved” group rather than in “Not improved” group (P < 0.01). When we supposed an iodine-unstained streak to be the predictive factor of the medication effect for GERD, sensitivity was 61.8% and specificity was 84.6%. No erosion was often found in the GERD cases without reflux esophagitis, and iodine-unstained streak was observed more often in “Improved” group rather than in “Not improved” group. We think that iodine-unstained streak can be useful for diagnosing of GERD and predictive factor of the medication effect.