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Background and ObjectiveGastroesophageal reflux disease(GERD) is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the oesophagus,in with symptoms of heartburn and reflux.GERD can be divided into three types:non-erosive reflux disease(NERD),erosive esophagitis(EE) and Barrett’s esophagus(BE).Although it is generally believed to occur less frequently in Asia when compared to the West,recent studies suggest that the prevalence of GERD in Asia is increasing.In fact,the majority of GERD patients have endoscopically normal-appearing esophageal mucosa;this group is termed non-erosive reflux disease (NERD) or endoscopy-negative reflux disease.NERD is associated with a huge economic burden.Endoscopy(oesophagogastro-duodenoscopy,EGD) is a Common and effective method for the diagnosis of EE and BE.the symptoms were similar in EE and NERD,but the severity of esophageal injury NERD less than EE.24 hours pH monitoring for GERD had a high sensitivity but not a routine examination in china. At present subjects with reflux diagnostic questionnaires(RDQ)in the initial diagnosis of NERD,So looking for a convenient and effective diagnostic methods are necessary.Los Angeles(LA) classification of oesophagitis is generally accepted as the endoscopic assessment of GERD.The Los Angeles(LA) classification is widely used for endoscopic assessment of GERD.The slightest degree of esophagitis,i.e.,grade A, is defined as one or more mucosal breaks confined to the mucosal folds,each no longer than 5 mm.Accordingly,this classification scheme ignores subtle mucosal damage in the absence of mucosal breaks.In this regard,Hoshihara et al.have proposed a modified LA system,in which grade O was subdivided into M and N, based on the concept of mucosal color changes.Thus,NERD patients can be classified into two subgroups(grade M and N) based on minimal esophageal involvement during endoscopy.this study to observe the minimal changes of gastroesophageal reflux disease(GERD),and to explore its main magnified endoscopic characteristics.Factors for GERD include defense mechanism weakened,acid reflux,dietary factors,psychosocial and Helicobacter pylori(Hp) infection.The role of Helicobacter pylori(Hp) in GERD also remains controversial,with several studies showing a protective effect,whereas others have shown improvement in symptomatology after H pylori eradication.There are limited data on the relationship between GERD and the psychosocial profile of a patient,especially with regards to response to treatment and natural history.This is in contrast to irritable bowel syndrome,where studies have shown significant psychopathology.In particular,data based on direct comparisons between erosive(EE) and NERD are lacking.This relationship is important because if significant psychopathology exists,this subgroup of patients may benefit from adjunctive psychotherapy,Materials and Methods1、standered to be selected:Aged 17-75 years old;At least three months of continuous or recurrent symptoms of acid reflux,heartburn,cardiac-like chest pain; Except for Nervous system diseases,Coronary Heart Disease,Diabetes,Peptic ulcer; Except for Serious Heart,Pulmonary,Liver,Renal Dysfunction,experienced surgery of Upper gastrointestinal surgery;Within two weeks no use of Proton Pump Inhibitors(PPI),Calcium channel blockers,acetylcholine antagonists;no history of allergies;Informed consent.2、Between April 2007 and January 2008,188 consecutive out-patients who visited or were referred to the Department of Gastroenterology,Male 92,Female 96. among them NERD70 Cases,EE70 Cases,BE48 Cases and normal control group20 Cases.3、Subjects with Self-rating Depression Scale(SDS)and Hamilton Anxiety Scale(HAMA) were evaluated in Disease and control group;Subjects with reflux disease questionnaire(RDQ) were evaluated NERD,EE group.4、The EGD using magnifying endoscope(GIF-Q240Z,Olympus) was performed under conscious sedation(diazepam 5-10mg/patient).Findings were documented. The presence or absence of columnar-lined epithelium(CLE) in the lower portion of oesophagus,reflux oesophagitis and the colour of gastric juice were examined by two expert endoscopists without knowledge of results of the questionnaire.The final findings of reflux oesophagitis and bile reflux(by colour of gastric juice) were determined by two expert endoscopists after discussion and review of the fiindings.5、After PPI treatment Completed RDQ again to Assessment the therapeutic effect.Results1、The shapes signature of Z-lines observed during magnification endoscopy: sleek oval shaped,sparsely serrated shaped,serrated shaped,tongue-like extension shaped,island shaped.The shape of mucosal pits were small round and oval,tubular, cladodromous,patching fluffiness and gyrus.Roughness of the mucosa below Z-line: flat,rough,white nodular changes,concavo-convex and villous mucosa.The shape of mucosal blood vessels were straight,helico,irregular,Complex shaped.Disease group was significantly different from that of the controls.2、Comparison the color and pH of gastric juice of Disease group was not significantly different from that of the controls.3、The difference of Depression Scale and Anxiety Scale between disease groups and the normal controls group existed significance.but between disease groups existed not statistical significance.4、The Hp infection Disease group was significantly different from that of the controls.5、The PPI therapeutic in effect Disease group was not significantly different. ConclusionHigh resolution endoscopic test will raise the diagnostic rate of NERD.NERD was divided into non-erosive esophagitis and symptomatic gastroesophageal reflux disease.
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