Minimal Change Esophagitis by i-Scan Endoscopy in Dyspeptic Patients
Minimal Change Esophagitis by i-Scan Endoscopy in Dyspeptic Patients
The purpose of this study to assess efficacy of SE endoscopy in the detection of MCE in
 dyspeptic patients with or without GERD diagnosed by GerdQ or by endoscopy + PHM and in
 normal volunteers.
Background: The association of minimal change esophagitis (MCE) with gastroesophageal reflux
 (GERD) is controversy. High resolution endoscopy may improve the detection of minimal change
 lesion (MCL). i- Scan endoscopy (SE) provides high resolution images with modulation of
 images for a specific purpose.

 Methods. All dyspeptic patients with or without GERD symptoms scheduled for endoscopy were
 recruited from February 2010 till July 2014. All completed the validated Thai version of
 GerdQ then underwent endoscopy. Forty normal volunteers were recruited for endoscopy and PHM
 test. The esophagus was examined by HD and SE with the TE-e mode sequentially. The captured
 images were independently evaluated for MCL (punctate erythema (PE), minute erosion (ME) and
 triangular lesion with elongated pit (EP) by three endoscopists. The agreement of > 2
 endoscopists was accepted as a final result. All had PHM within 1 week after the endoscopy.
 GERD was diagnosed by LA grade A-D esophagitis and/or PHM with acid exposure time > the upper
 limit of volunteer and/or positive symptom index and/or positive Symptom Association
 Probability. MCE was diagnosed when PE, ME or EP or the combination of these were present.

 The 40 normal volunteers were recruited for performing pH monitoring. The PHM data of 40
 volunteers were analyzed to set the upper normal limit of total acid exposure time in our
 population. The mean + 2SD of total acid exposure time of volunteers was 1.9%.

 Definition. GerdQ. The Thai version of GerdQ was translated from the English version. The
 contents of the GerdQ were tested by back translation from Thai to English by 5 personnel who
 are fluent in English and all showed the consistent contents. The reliability of the GerdQ
 was validated in 22 volunteers completing the questionnaire twice with 3 hours in between and
 showed no significant difference of the mean score (5.14+ 2.34 vs 6.23+ 1.57, p=0.07) and the
 number of subjects with GERD diagnosed by the GerdQ (2 vs 5, Fisher's extact test, p=0.21) .

 GERD is diagnosed when total acid exposure time is more than 2% or positive symptom index
 (SI) or positive symptom association probability ( SAP ) or endoscopy revealed LA erosive
 esophagitis > grade A.
Inclusion Criteria:

 -  Patients with one or more of the following symptoms namely epigastric pain or
 discomfort, postprandial fullness and early satiety with or without symptoms
 suggesting GERD

 -  Patients able to give informed consent

 Exclusion Criteria:

 -  Patients with significant weight loss.

 -  Patients with hematemesis, melena ,dysphagia, intractable vomiting , palpable
 abdominal mass.

 -  Patients with history of documented peptic ulcer , gastric surgery , gastric cancer.

 -  Patients with symptoms compatible with irritable bowel syndrome, hepatobiliary tract
 disease.

 -  Patients with severe concomitant medical conditions, pregnant woman or continuous
 usage of steroids or NSIADS in the preceding 1 month before entry to the study.