Endoscopic diagnosis of non-erosive reflux disease

Figure 1 Histological characteristics of the esophageal epithelium stained with hematoxylin-eosin[9]. A: Mild hyperplasia of basal cells; B: Increased thickness of the basal zone and elongation of papillae in the epithelium, accompanied by neutrophil and eosinophil infiltration. Adapted from Zhang et al[9]. Citation: Zhang NN, Ma YM, Sun Q, Shi LL, Xie Y, Zou XP. Evaluation of Minimal Change Lesions Using Linked Color Imaging in Patients With Nonerosive Reflux Esophagitis. J Clin Gastroenterol 2022; 56: 405-411. Copyright ©Wolters Kluwer Health, Inc. 2021. Published by Wolters Kluwer Health, Inc. (Supplementary material).

Figure 2 Subtle changes of non-erosive reflux disease under blue laser imaging and linked color imaging. A: Increased number, dilation, and tortuosity of intrapapillary capillary loops under blue laser imaging combined with magnifying endoscopy; B: Reddish mucosal changes and prominent gastric mucosal folds observed at the squamocolumnar junction under linked color imaging. BLI: Blue laser imaging; LCI: Linked color imaging.

Figure 3 Minimal lesions of non-erosive reflux disease under narrow band imaging. A: Increased number, dilation, and tortuosity of intrapapillary capillary loops; B: Micro-erosions identified around the Z-line. NBI: Narrow band imaging.

Figure 4 Optical enhancement improves visualization of intrapapillary capillary loops and their morphological changes compared to white-light endoscopy. A: Under white-light endoscopy, intrapapillary capillary loops (IPCLs) are difficult to visualize; B: Optical enhancement technology significantly improves vascular contrast, facilitating clearer visualization of IPCLs; C and D: Optical enhancement demonstrates increased number, dilation, and tortuosity of IPCLs.

Figure 5 Autofluorescence imaging and confocal laser endomicroscopy reveal distinct features of normal esophageal mucosa and non-erosive reflux disease[27,28]. A: Normal esophageal mucosa under autofluorescence imaging; B: Longitudinal purple lines visualized under autofluorescence imaging; C: Esophageal mucosal appearance in healthy controls under confocal laser endomicroscopy; D: Dilated intercellular spaces and increased, dilated intrapapillary capillary loops (arrow) in non-erosive reflux disease patients under confocal laser endomicroscopy. Descriptions of subfigures A and B (adapted from Luo et al[27]). Citation: Luo X, Guo XX, Wang WF, Peng LH, Yang YS, Uedo N. Autofluorescence imaging endoscopy can distinguish non-erosive reflux disease from functional heartburn: A pilot study. World J Gastroenterol 2016; 22: 3845-3851. Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc.; descriptions of subfigures C and D (adapted from Chu et al[28]). Citation: Chu CL, Zhen YB, Lv GP, Li CQ, Li Z, Qi QQ, Gu XM, Yu T, Zhang TG, Zhou CJ, Rui-Ji, Li YQ. Microalterations of esophagus in patients with non-erosive reflux disease: In-vivo diagnosis by confocal laser endomicroscopy and its relationship with gastroesophageal reflux. Am J Gastroenterol 2012; 107: 864-874. Copyright ©The American College of Gastroenterology 2012. Published by Wolters Kluwer Health, Inc. (Supplementary material).

Figure 6 Proposed diagnostic algorithm incorporating advanced endoscopy into the diagnostic pathway for gastroesophageal reflux disease and non-erosive reflux disease. AET: Acid exposure time; AFI: Autofluorescence imaging; BLI: Blue laser imaging; CLE: Confocal laser endomicroscopy; GERD: Gastroesophageal reflux disease; LA: Los Angeles; LCI: Linked color imaging; MCLs: Minimal change lesions; MNBI: Mean nocturnal baseline impedance; NBI: Narrow-band imaging; OE: Optical enhancement; PPIs: Proton pump inhibitors.