食管末端及胃食管连接处的肠化生、异型增生和肿瘤发病情况

目的 了解我国人食管末端和胃－食管连接处的肠化生（IM）及异型增生和肿瘤的发病状况，齿状线（SCJ）位置和反流性食管炎（RE）的关系。方法 调查记录391例患者的症状，胃镜下RE的表现，并根据SCJ的位置分为3组，其中，胃镜下见齿状线上移≥3cm为A组，＜3cm为B组，齿状线和GEJ同一水平的为C组。每例患者均于齿状线远端活检送病理检查。结果 A，B，C，3组IM发生率分别为26.53%,33.85%,34.00%;IM的发生在40岁以后随着年龄增长逐渐增加，男女之间无差异；361例患者中共诊断异型增生12例（轻度7例，中重度5例），贲门癌16例，食管腺癌1例；A，B，C3组RE的发病率分别为57．14％，22．83％，12．00％。结论 1．胃镜下提示为LSBE，SSBE和GEJ三组间的IM发生率无显著差异；2．应重视食管末端及胃－食管连接处异型增生的诊断；3．贲门癌发病远高于食管腺癌。     

Barrett食管、贲门部与胃窦部肠上皮化生的比较研究

目的比较Barrett食管(BE)肠上皮化生(IM)、贲门肠上皮化生(CIM)与胃窦部肠上皮化生(GA-IM)黏液组织化学检查结果及病因学的差异。方法联合应用AB/PAS及HID/AB染色对上述不同部位IM进行分型,分为3种亚型:完全小肠型(Ⅰ型)、不完全小肠型(Ⅱ型)及不完全大肠型(Ⅲ型)。比较各部位IM中3种亚型所占的比例,同时分析它们与胃食管反流病(GERD)及幽门螺杆菌(Hp)感染之间的关系。结果长节段BE(LSBE)及短节段BE(SSBE)中主要以Ⅲ型IM为主,分别占75.0%、63.3%,显著高于CIM(23.1%)及GA-IM(17.7%)(P均<0.01)。LSBE、SSBE、CIM及GA-IM中GERD症状阳性率依次为78.6%、76.7%、42.3%及17.7%,前三者显著高于后者(P 均<0.01);而Hp感染率则相反,LSBE、SSBE、CIM及GA-IM依次为17.9%、20.0%、46.2%及64.7%,LSBE、SSBE显著低于CIM及GA-IM(P均<0.01)。结论LSBE、SSBE中主要以Ⅲ型IM为主,而CIM及GA-IM中Ⅲ型IM发生率较低。LSBE、SSBE与GERD显著相关,与Hp感染不相关,而CIM及GA-IM主要与Hp感染有关,GERD可能也参与CIM的发生。     

Barrett′s食管的肠上皮化生研究

目的探讨影响Ｂａｒｒｅｔｔ′ｓ食管（Ｂａｒｅｔｔ′ｓ ｅｓｏｐｈａｇｕｓ,ＢＥ）粘膜中肠上皮化生（ｉｎｔｅｓｔｉｎａｌ ｍｅｔａ－ｐｌａｓｉａ,ＩＭ）发生的因素。方法应用胃镜下和组织学染色方法诊断ＩＭ,并比较３６例存在ＩＭ的ＢＥ患者与１１例不伴有ＩＭ的ＢＥ患者在年龄、胃镜下表现及食管运动功能方面的特点。结果ＢＥ患者的年龄、胃镜下ＢＥ粘膜的长度及形态,均与ＩＭ的发生率有关（Ｐ〈０．０５）;但食管炎的     

Barrett食管研究进展

Barrett食管（Barrett＇s esophagus，BE）是指鳞柱状上皮结合部移行至胃食管连接部近端且伴有肠腺化生的疾病。BE是一种癌前病变，与食管腺癌关系密切。近年来BE的发病率呈逐年上升趋势，已成为西方国家食管腺癌发病率大幅度增高的直接原因。本就BE的发病机制、筛查与监测、异型增生的检测及内镜下消融治疗等方面的研究进展进行综述。     

Barrett食管内镜活检诊断方法

一、关于Barrett食管定义 Barrett食管（BE）早期的概念是指食管先天性胃上皮化生或柱状上皮衬覆的先天性短节食管，为与食管下段的贲门黏膜区分，曾规定病变长径在胃食管连接处（GEJ）3cm以上（即所谓的3cm法则）。     

NBI诊断Barrett食管伴特殊肠化生的临床价值

目的:探讨内镜窄带成像技术(narrow-band imaging,NBI)对诊断Barrett食管(Barrett’s esophagus,BE)伴特殊肠上皮化生(specialized intestinal metaplasia,SIM)的临床应用价值.方法:选择2012-01/2012-12经胃镜检查诊断为内镜BE的患者47例,按普通内镜、NBI顺序进行观察,对图像的清晰度进行比较;放大观察BE黏膜的腺管开口形态及浅表毛细血管结构形态,并对腺管开口形态进行Goda分型,于改变最显著部位取活检进行病理检查,将诊断结果与最终病理诊断结果进行对比分析,统计SIM检出率.结果:两者对鳞-柱状上皮交界处病变轮廓、BE黏膜的腺管开口形态及毛细血管结构的显示有统计学差异,NBI明显优于普通内镜.NBI下根据Goda分型,其Ⅳ型及Ⅴ型检出SIM的准确性、敏感性及特异性分别达92%、85%及94%.结论:NBI对病变轮廓、BE黏膜腺管开口及浅表毛细血管结构形态显示更加清晰,能提高SIM的检出率,具有良好的临床实用价值.     

CDX2与胃上皮化生研究进展

此文介绍了果蝇同源异型框转录因子(CDX2)的结构与功能,CDX2转基因鼠及CDX2与胃癌、肠化生、胃食管连接处肠上皮化生等近几年的研究情况,分析了CDX2作为特异性的早期肠转录因子在肠化生早期表达的重要意义.而CDX2与胃癌预后是否有关,还需要进一步研究,其可能是早期肠型胃癌的进展标志.     

Barrett食管的病因与流行病学

Barrett食管（BE）是一种具有重要临床意义的食管疾病。它与食管腺癌的发生密切相关，是一种主要的食管腺癌癌前病变，欧美近年来食管一胃交界部腺癌发生率明显升高，为所有恶性肿瘤中增长速度最快的一种，食管的原发性腺癌中约50％来自BE。     

Barrett食管的诊断和随访

近 20多年,食管腺癌和贲门癌的发病率在西方国家和亚洲地区均呈上升趋势,尤其是北美和西欧 [1]。食管腺癌的发生和 Barrett食管 (BE)有直接的关系。大量的研究发现,食管末端的腺癌几乎都产生于 BE,而 40％的贲门（胃－食管交界处）癌同 BE有关 [2,3]。 　　一、 BE的定义 :BE是在 1950年由一位名叫 Norman.Barrett的英国心胸外科医生首次报道,并以他的名字命名 [4]。 　　BE的最初定义 [5]：食管远端的正常鳞状上皮被柱状上皮所替代,其受累长度≥ 3cm,也称为长节段 BE（ Long－ segment Barrett's Esophagus,LSBE) [6]。 …     

食管胃连接处疾病的病因学和形态学研究现状

食管胃连接处（EGJ）系指食管与胃的交界,其组织学具有特殊性。贲门部是连接远端食管与胃底黏膜的区域,贲门是否存在及其真实长度仍存有争议。EGJ所涉及的疾病主要有贲门炎、反流性食管炎（RE）和Barrett食管（BE）,三者间存在一定的联系.     

Significance of Intestinal Metaplasia in Different Areas of Esophagus Including Esophagogastric Junction

Over the past two decades, the incidence ofadenocarcinoma of the esophagus and gastric cardia hasincreased at a rate exceeding that of any other cancer.Barrett's esophagus is the only known risk factor for these malignancies. Recently, emphasis hasbeen placed on the significance of specializedintestinal metaplasia (SIM) on esophageal biopsies. Ouraim was to compare the prevalence of SIM at different esophageal locations in patients who are athigher risk of developing esophageal adenocarcinoma(Caucasians) and patients with lower risk of developingesophageal adenocarcinoma (African-Americans).Eighty-seven unselected patients (42 Caucasians and 45African-Americans) underwent routine upper endoscopywith biopsies from the proximal margin of columnarmucosa. We classified patients into those with acolumnar-lined esophagus with SIM (CLE with SIM); CLE withoutSIM; or SIM with a normal-appearing gastroesophagealjunction (SIM-GEJ). The prevalence of CLE with SIM, CLEwithout SIM, and SIM-GEJ was 28%, 10%, and 10% in Caucasians compared to 0%, 18% and 11% inAfrican-Americans (P = 0.0001, 0.26, and 0.81,respectively). We found CLE with SIM only in patientswith reflux symptoms at least twice a week. It isconcluded that CLE with SIM is seen most commonly inpatients thought to be at risk for esophagealadenocarcinoma (Caucasians with reflux symptoms). It israrely seen in other groups with lower risk for thismalignancy (African-Americans, nonrefluxers). Conversely,SIM-GEJ and CLE without SIM are common in all groups andare of questionable significance.     

Self-Expanding Metal Stents for Palliation of Inoperable Carcinoma of the Esophagus and Gastroesophageal Junction

Objectives: Rapid palliation of malignant dysphagia is usually possible with endoscopic implantation of plastic prosthesis, but this device has a high rate of complications. Recently expandable metal stents have become available that may have a reduced complications rate.
Methods: This report details our experience with 32 patients treated from September of 1992 through June of 1994. Twenty-three patients were treated primarily with the Ultraflex esophageal prosthesis, and five patients were treated with postoperative malignant stricture, three with failed laser therapy and one with postradiation therapy malignant stricturing. Implantation was successful in 30/32 patients (94%). No major bleeding or perforation followed placement. The dysphagia score improved dramatically from 3 to 0.5. Twenty-six patients had a follow-up of at least 30 days. No stent migration occurred. Food impaction was seen in three patients, tumor ingrowth in three, and overgrowth in one patient. The median survival was 6.2 months with a range of 1.8–11.3 months.
Conclusions: Expandable metal stents are effective and safe for palliation of malignant obstruction of the esophagus and gastro-esoph-ageal junction. However, long term problems remain to be addressed, such as ingrowth by tumor, food impaction, and limitation of stent expansion by tumor rigidity.     

Prospective Evaluation of Intestinal Metaplasia and Dysplasia Within the Cardia of Patients with Barrett's Esophagus

The prevalence of cardia versus noncardiagastric intestinal metaplasia in patients with Barrett'sesophagus was assessed prospectively. Four-quadrantbiopsies were obtained from the cardia from 119consecutive patients with Barrett's esophagus and 64control patients. Gastric surveillance biopsies wereobtained in 108 of the Barrett's patients and 58 controlpatients. There was a significantly greater prevalence of cardia intestinal metaplasia inshort-segment Barrett's (10.2%), but not traditionalBarrett's (3.3%), compared to control patients (0%) (P= 0.009). Dysplastic changes were significantly morefrequent in the metaplastic epithelium within theesophagus than in the cardia (P < 0.0001). Asignificantly greater prevalence of noncardia intestinalmetaplasia compared to cardia intestinal metaplasia wasfound in each of the three groups of patients;however, the prevalence of noncardia intestinalmetaplasia between short-segment, traditional, andcontrol patients was not significantly different. Cardiaintestinal metaplasia was an infrequent finding inpatients with Barrett's esophagus and appears to developindependently from that in the remainder of thestomach.     

Barrett食管和食管腺癌:东西方的差异

食管癌是一种常见的消化道恶性肿瘤．位居全球恶性肿瘤发病率的第八位，死亡率的第六位。我国是食管癌高发地区之一，食管癌的死亡率位居世界首位。虽然近年来食管癌的死亡率有所下降．但降低趋势并不明显，在一些食管癌的高发区，其发病率和死亡率仍然维持在较高水平。Barrett食管（Barrett esophagus，BE）是食管远端鳞状上皮组织被柱状上皮组织所替代，尤其是柱状上皮伴有肠上皮化生存在。近年其发病率呈明显上升趋势．由于BE与食管腺癌（esophageal adenocarcinoma，EA）的发生密切相关而日益受到广泛重视。本文就Barrett食管和食管癌在东西方国家的差异简述如下。     

Defective Mucosal Movement at the Gastroesophageal Junction in Patients with Gastroesophageal Reflux Disease

Background

Little is known about the role of muscularis mucosa at the gastroesophageal junction (GEJ).

Aim

To evaluate the movement of the mucosa/muscularis-mucosa/submucosa (MMS) at the GEJ in normal subjects and in patients with gastroesophageal reflux disease (GERD).

Methods

Gastroesophageal junctions of 20 non-GERD subjects and 10 patients with GERD were evaluated during 5 mL swallows using two methods: in high-resolution endoluminal ultrasound and manometry, the change in the GEJ luminal pressures and cross-sectional area of esophageal wall layers were measured; in abdominal ultrasound, the MMS movement at the GEJ was analyzed.

Results

Endoluminal ultrasound: In the non-GERD subjects, the gastric MMS moved rostrally into the distal esophagus at 2.17 s after the bolus first reached the GEJ. In GERD patients, the gastric MMS did not move rostrally into the distal esophagus. The maximum change in cross-sectional area of gastroesophageal MMS in non-GERD subjects and in GERD patients was 289 % and 183 %, respectively. Abdominal ultrasound: In non-GERD subjects, the gastric MMS starts to move rostrally significantly earlier and to a greater distance than muscularis propria (MP) after the initiation of the swallow (1.75 vs. 3.00 s) and (13.97 vs. 8.91 mm). In GERD patients, there is no significant difference in the movement of gastric MMS compared to MP (6.74 vs. 6.09 mm). The independent movement of the gastric MMS in GERD subjects was significantly less than in non-GERD subjects.

Conclusion

In non-GERD subjects, the gastric MMS moves rostrally into the distal esophagus during deglutitive inhibition and forms a barrier. This movement of the MMS is defective in patients with GERD.