A GEFV that remained tightly snug to the endoscope was categorized as grade I. Each GEFV was graded using Hill's classification from grade I to IV as described previously 6. Barrett’s esophagus (BE) was diagnosed by confirmation of intestinal metaplasia by pathology.
Esophagitis was diagnosed and graded by the Los Angeles classification 8. In the present study, we aimed to assess the correlations between GEFV grading and the classification of GERD by the Lyon Consensus and to explore the relationship of GEFV grading with the MNBI and PSPWI, EGJ morphology, EGJ tone, and esophageal body motility.Īll patients underwent upper gastrointestinal (GI) endoscopy using a GIF-260 upper GI endoscope (Olympus, Hamburg, Germany) under intravenous anesthesia or topical anesthesia. However, the GEFV is not included in the Lyon Consensus, and studies on the potential associations between GEFV grading and GERD classification by the Lyon Consensus, mucosal integrity, esophageal peristaltic function, and EGJ are limited. Previous studies have found that GEFV grade is positively associated with acid reflux and could reflect EGJ morphology 7. The gastroesophageal flap valve (GEFV) serves as the anti-reflux barrier and is easily visualized with a retroflexed endoscope with an excellent inter-observer agreement 6.
The esophagogastric junction (EGJ) is important for the prevention of GERD 5. On the other hand, the PSPWI highlights the integrity of primary peristalsis initiated by reflux 4. The MNBI reflects the reflux-induced impairment of mucosal integrity 3, 4. The mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPWI) are two novel parameters detected on MII-pH and regarded as supportive parameters for detecting GERD 2. MII-pH monitoring is used increasingly often for diagnosing GERD. Accordingly, the evidence for GERD is classified as follows: conclusive evidence for pathologic reflux, borderline or inconclusive evidence, adjunctive or supportive evidence, and evidence against pathological reflux 2. The Lyon Consensus was developed to aid the diagnosis of GERD based on 24-h multichannel intraluminal impedance-pH (MII-pH), upper gastrointestinal endoscopy, and high-resolution manometry (HRM). Hence, accurate and timely diagnosis of GERD is important. Although it is a benign disease, longstanding GERD can lead to Barrett's esophagus (BE), a premalignant condition 1. Gastroesophageal reflux disease (GERD) is a common clinical condition. GEFV grading might be regarded as supportive evidence for GERD diagnosis. Further, when identifying patients with conclusive evidence of GERD, abnormal GEFV had a specificity of 80.4% (95% CI 75.3–85.5%). Patients with an abnormal GEFV had a significantly greater risk of conclusive evidence of GERD compared to those with a normal GEFV (OR 3.035, 95% CI 1.758–5.240, P < 0.001). AET% and EGJ morphology showed positive correlations with GEFV grade, while PSPWI and MNBI showed negative correlations. 33.3 %, P < 0.001) were significantly lower in the abnormal GEFV group compared with the normal GEFV group. 2228.5 Ω, P = 0.012) and post-reflux swallow-induced peristaltic wave index (PSPWI) (19.7 vs. 172, P = 0.011) were significantly higher, while the mean nocturnal baseline impedance (MNBI) (2068.3 vs. 1.3, P < 0.001) and the proportion of abnormal esophagogastric junction (EGJ) morphology (71 vs. The percentage of acid exposure time (AET%)(4.2 vs. To investigate the value of GEFV grading in GERD, the clinical data of 320 patients with GERD symptoms who underwent endoscopy, 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring, and high-resolution manometry (HRM) were retrospectively analyzed. There is limited information about the association between GEFV abnormality and novel parameters in patients with gastroesophageal reflux disease(GERD) symptoms by the Lyon Consensus. Gastroesophageal flap valve (GEFV) grading is a simple and reproducible parameter.
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