胃食管反流病的诊断

胃食管反流性疾病(gastroesophageal reflux disease，GERD)是由于胃、十二指肠内容物反流人食管引起的一组临床症状和食管的组织损害。主要表现为烧心、反流、胸骨后疼痛三大症状。酸(碱)反流导致的食管黏膜破损称为反流性食管炎(reflux esophagitis，RE)。新近的研究证明，胃食管反流(GER)与部分哮喘，咳嗽，夜间呼吸暂停，心绞痛样胸骨后疼痛有关。若食管炎症长期存在，可发展成为具有一定癌变倾向的Barrett食管。西方国家人群中7％～15％有GER症状。男女患病比例相似。     

胆汁反流与Barrett食管

Barrett食管(Barrett’s esophagus，BE)是食管复层鳞状上皮细胞被单层柱状上皮细胞取代的一种病理现象，组织学表现为含有杯状细胞和柱状细胞的肠上皮化生，在形态学和超微结构上具有鳞状上皮和柱状上皮的特点。BE被认为是胃食管反流病(gastroesophageal reflux disease，GERD)最严重的并发症，对伴有GERD症状的患者进行胃镜检查时，约有12％的患者被发现BE。目前认为BE是食管腺癌的先兆，属癌前状态，约有10％的BE患者可能发展为食管腺癌。     

58例早产儿胃食管反流的护理干预

探讨预防早产儿胃食管反流(gastroesophageal reflux,GER)的护理方法,对我科收治的58例有胃食管反流的早产儿采取消化道护理、体位护理、抚触等护理干预,可有效减少早产儿的胃食管反流,患儿住院期间体重均有所增加,治疗好转出院。     

54例Barrett食管临床研究

目的 分析Barrett食管（barrecc esophagus，BE）患者的临床特点，尤其是胃镜下表现度食管动力改变，以提高BE的诊断率，以期早期治疗。方法 回顾分析54例BE患者的临床资料。结果 22例行食管动力检查提示LESP厦屏障压（LESP-GS）明显降低，酸反流总时间、酸反流总次数以度食管下段pH〈4时间百分比均明显增加。系统治疗后，41例患者在该院行胃镜复诊，21例（51．22％）仍为BE，19例（46．34％）患者恢复正常食管上皮，1例（2．44％）进展为食管腺癌。结论 BE是胃食管反流痛（gastroesophageal reflux disease，GERD）严重的并发症；内镜下治疗联合抑酸治疗为BE治疗提供新的方法。     

胃食管反流病的临床表现分类及精准治疗策略

正胃食管反流病(gastroesophageal reflux disease,GERD)是胃内容物反流到食管引起的症状和(或)并发症,常见的典型症状包括烧心和反流,也可引起包括耳、鼻、喉等的相关症状,称为食管外症状~([1])。根据胃镜下所见,一般可将GERD分为非糜烂性反流病(non-erosive reflux disease, NERD)、糜烂性食管炎(反流性食管炎)及巴雷特食管(Barrett esophagus, BE)3种~([1])。根据2006年蒙特利尔全球GERD共识,则可将其分为食管综合征和食管外综合征,     

慢性阻塞性肺疾病应用抗胃食管反流治疗的探讨

慢性阻塞性肺疾病（chronic obstructive pulmonary diseases，COPD）是临床常见病、多发病。COPD合并胃-食管反流（gastroesophageal reflux，GER）的病人并不少见，COPD与胃食管反流关系密切，两者相互影响，互为因果。临床上常因COPD疾患本身的不适而忽略了胃食管反流的存在，为探讨抗胃食管反流治疗在COPD中的应用价值，笔者进行了这方面的研究，现报告如下。     

胃食管反流病相关性耳鼻咽喉表现

胃食管反流病(gastroesophageal reflux disease, GERD)是指胃内容物反流入食管引起的症状或并发症,典型症状为胸骨后烧灼感、反酸, 严重时可引起反流性食管炎,甚至Barrett食管[1].随着流行病学和病理生理学研究的深入,GERD引起的食管外表现越来越受到消化科和相关学科的重视.     

新型Barrett食管、食管腺癌动物模型及COX-2对其发生的影响

目的：建立新型安全的Barrett食管（BE）及食管腺癌（EA）动物模型，并探讨环氧合酶-2（COX-2）表达在BE、EA发生发展中的作用，、方法：150只SD大鼠分为对照组、铁剂组、反流组、反流铁剂组，后两组行手术造成十二指肠胃食管反流，铁剂组、反流铁剂组大鼠腹腔注射右旋糖酐铁（5mg／kg，每周2次，共22同）。术后8周每组各处死5只，24周后全部处死，取得食管标本进行组织形态学研究观察大鼠食管BE及EA的发生情况，应用SP免疫组化染色检测COX-2的表达。结果：对照组与铁剂组未发生BE和EA，反流铁剂组BE、异型增生及EA的发生率高于反流组（P〈0．05）．反流铁剂组COX-2表达阳性率及阳性程度高于其他组（P〈0．05）。COX-2在肿瘤中表达最高，异型增生中次之，正常黏膜表达最低。结论：应用手术致食管反流并注射铁剂的方法制作大鼠BE及EA模型成功率高．安全性好．COX-2表达的增加可能与BE及EA的发生发展有关     

Barrett食管及食管腺癌分子标记物的研究进展

Barrett食管(BE)是食管腺癌(EA)的癌前病变。准确诊断BE,是降低EA风险的主要手段。近10余年来,EA的发病率在西方国家明显增加,在国内也有上升趋势,并引起广泛重视。由于有时内窥镜下识别食管胃交界解剖部位存在困难,显微镜下又不易区别BE肠化和胃贲门肠化,使一些BE不能准确诊断。本文对BE及EA近年来蛋白及分子标记物的研究进行综述,希望对BE及EA的诊断提供有益的思路。     

非糜烂性反流病诊断研究中的几个热点问题

胃食管反流病（gastroesophageal reflux disease,GERD）是指胃内容物反流入食管引起不适症状和（或）并发症的一种疾病[1].2006年蒙特利尔共识意见对GERD进行了重新定义和分类.GERD分为食管综合征和食管外综合征.前者包括症状综合征（典型反流症状和反流相关胸痛）和食管损伤综合征[反流性食管炎,食管狭窄,Barrett＇s食管（Barrett＇s esophagous,BE）及食管腺癌];后者包括一些已肯定与反流相关的综合征如反流性咳嗽、反流性喉炎、反流性哮喘及反流性牙侵蚀,同时还包括了一些与反流可能相关的综合征如咽炎、鼻窦炎、特发性肺纤维化及复发性中耳炎.根据内镜所见,一般还可将GERD分为非糜烂性反流病（non-erosive reflux diseases,NERD）、糜烂性食管炎（erosive esophagitis,EE）及BE三种类型[2].     

Barrett食管与食管腺癌——3例报告及文献复习

目的Barrett食管在我国少见,故复习文献并报告Barrett食管合并食管腺癌3例。方法复习北京协和医院近10年来手术切除的食管癌病例,其中Barrett食管合并食管腺癌仅有3例。结果3例均为男性,平均年龄56岁。2例为贲门型／交界型Barrett食管,1例为特异型Barrett食管;其中1例合并印戒细胞癌,2例合并低分化腺癌。结论诊断Barrett食管时应注意病变的解剖学部位,以避兔过度诊断。     

The definition of Barrett's esophagus

Recently, according to increasing gastroesophageal reflux disease (GERD), the patients with Barrett's esophagus (BE) are increasing. Since Barrett have reported cases of esophageal ulcers surrounding by columnar epithelium, the various criteria of the BE have been proposed. In 1998, practice guidelines for BE were developed under the auspices of the American College of Gastroenterology. They proposed that BE was a chance in the esophageal epithelium of any length that can be recognized at endoscopy, and confirmed to have intestinal metaplasia by biopsy of the tubular esophagus and excludes intestinal metaplasia of the cardia. Endoscopically, BE is determined, when 'gastric-appearing mucosa' or apparent 'columnar lined esophagus' is evident proximal to the esophagogastric junction. Histologically, BE has double muscularis mucosae, and contains a mixture cell types; gastric-fundic type epithelium, junctional type epithelium, and specialized columnar epithelium (SCE). Especially SCE is distinctive features of BE, available for diagnosis. On the other hand, BE is premalignant condition for the adenocarcinoma of the esophagus, therefore the features of the BE are researched to prevent and find out earlier development of adenocarcinoma. In this review, we referred to the definition of BE with some topics.     

智能电子分光技术在Barrett食管诊断中的初步研究

目的 观察智能电子分光技术(FICE)在Barrett食管(BE)及早期食管腺癌(EA)诊断中的价值.方法 2006年6月～2008年12月该院胃镜检查的患者16 000例次,对其食道下端随机采用传统白光或FICE技术观察.FICE内镜检查组拟诊BE 133例(实验组);普通内镜检查组拟诊BE 128例(对照组),对检查部位进行活检,并与组织学诊断进行对比.结果 实验组确定BE 127例(95.5％),其中轻度不典型增生(LGD)13例(9.77％)、高度不典型增生(HGD) 10例(7.51％)、EA 9例(6.02％);对照组确定BE 105例(82.O％),其LGD 10例(7.81％)、HGD 3例(2.45％)、EA 2例(1.56％),实验组除LGD外,其余检出率均明显高于对照组(P＜0.05).结论 FICE对BE病灶发现及指导活检优于普通白光内镜.     

Smokeless Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in Male Patients With Gastroesophageal Reflux Disease

Objective

To investigate the effect of smokeless tobacco (ST), cigar and/or pipe smoking (CP) on the development of Barrett esophagus (BE) in white male patients with gastroesophageal reflux disease (GERD).

高频腔内超声对胃食管反流患者食管运动功能的评价

目的 应用高频腔内超声与食管测压同步检测胃食管反流病(GERD)患者的食管运动功能异常情况,并尝试论证腔内超声评估食管运动功能异常的有效性和可行性,以及食管压力与食管壁肌层厚度之间的关系.方法 10例经内镜及24 h食管pH检测确诊为GERD的患者,5例正常志愿者作为对照.经鼻腔导入高频超声探头(频率20 MHz,直径1.9 mm)及四通道水灌注式测压导管,在观察静息及吞咽时食管压力变化的同时,同步记录食管的运动影像,并计算出下食管括约肌上端5 cm、10 cm、1 5 cm及20 cm处食管环形肌和纵形肌的收缩指数、收缩周期及食管截面积.同时,通过测压导管同步监测湿咽时食管的最大压力值,计算其与同一位置的食管最大肌层厚度之间的相关性.结果 10例GERD患者与正常对照组相比,食管各段环形肌、纵形肌收缩指数均明显缩小(P＜0.05);收缩周期有延长的趋势;而最大截面积与正常对照组差异无统计学意义(P＞0.05).食管各段的最大压力值与同一部位的最大肌层厚度之间存在正相关(r=0.552～0.736).结论 食管各部位的最大压力值与最大肌层厚度之间存在正相关;GERD患者存在食管运动功能的异常,食管壁的舒缩能力下降以及收缩周期延长可能影响食管的廓清力,从而与GERD的发病有直接关系;同时,高频腔内超声为功能性胃肠病的诊断及其临床研究提供了一种新的方法.     

Clinical experience with the Stretta procedure

The benchmarks in GERD therapy comprise the commonly prescribed anti-secretory drugs (H2RAs and PPIs) and anti-reflux surgery. Although drugs are typically safe, cost and patient compliance are challenges to long-term management. Furthermore, while heartburn may be controlled with aggressive medical therapy, other symptoms such as regurgitation may persist, reducing patient satisfaction and adversely affecting quality of life. Surgical anti-reflux procedures, most commonly laparoscopic Nissen fundoplication, improve GERD symptoms and normalize esophageal acid exposure in most patients. Patient perception of the potential risk of abdominal surgery and general anesthesia may limit willingness to undergo surgery resulting in only a small portion of GERD sufferers that actually undergo anti-reflux surgery each year. Overall, the Stretta procedure is well tolerated, with an acceptably low incidence of complications and obviates the need for anti-secretory drug therapy for most patients at the 6- and 12-month follow-up. GERD symptom scores, heartburn, satisfaction, and SF-36 scores significantly improve over the baseline and this effect lasts at least 12 months. The symptomatic improvement after Stretta at 12 months in one trial (GERD score, 27 to 9) is similar to that reported by Velanovich after fundoplication (GERD score, 27 to 3). Furthermore, the significant reduction in median esophageal acid exposure time (distal 10.6% to 6.2%, proximal 1.9% to 0.9%), provides objective evidence of an anti-reflux effect. Although the reported studies have been non-randomized, the objective improvement observed in esophageal acid exposure and the persistence of GERD symptom score improvement with repeated measure analysis over a course of 12 months make a significant placebo effect unlikely. Stretta is a promising new technology for the treatment of GERD that should be considered for patients who wish to discontinue a lifelong anti-secretory medication regimen or who have incomplete GERD symptom control on drugs, but are not yet accepting anti-reflux surgery.     

Role of minimally invasive surgery in the modern treatment of Barrett's esophagus

Gastroesophageal reflux disease (GERD) is a highly prevalent disease. Population studies have demonstrated that a significant proportion of individuals weekly experience GERD symptoms. Barrett's esophagus (BE), defined by the presence of intestinal metaplasia (columnar epithelium with goblet cells), is considered a consequence of chronic reflux. This review defines the role of surgery in the modern treatment of BE, taking into consideration the pathophysiology of the disease and the new endoscopic procedures available at present.