共聚焦显微内镜下Barrett食管上皮的分布特点

目的 探讨共聚焦显微内镜下Barrett食管(BE)上皮类型的分布特点.方法 选取胃镜检查疑诊为BE的112例患者纳入研究,对食管下段柱状上皮进行共聚焦内镜检查,实时预测BE上皮类型、判断肠上皮化生的累及范围,随后对所检查部位黏膜行活组织病理检查,分析普通内镜和共聚焦显微内镜表现与病理组织学诊断结果的关系.结果 共计94例患者被确诊为BE,普通内镜下以岛型最为常见(54.3％),短段BE比例显著高于长段BE(86.2％比13.8％),共聚焦显微内镜下可分辨特殊肠上皮化生、贲门腺和胃底腺上皮,其准确度分别为94.7％、89.4％和91.5％.靶向活组织病理检查发现长段BE中的肠上皮化生比例(9/13)高于短段BE(33.3％,x2=4.684,P=0.039),环周型和舌型BE的肠上皮化生比例(11/17和65.4％)均显著高于岛型(15.7％,x2值分别=15.217和19.399,P值均＜0.01).短段BE与长段BE间,岛型、环周型和舌型BE间的肠上皮化生范围均无明显差异.结论 共聚焦显微内镜可准确分辨BE上皮的组织类型,镜下形态以岛型多见,但环周型和舌型的肠上皮化生比例更高,长段BE中的肠上皮化生比例高于短段BE.     

Barrett食管临床及内镜特点与病理关系分析

目的分析Barrett食管（Barrett’s esophagus,BE）临床症状、镜下表现及病理特点,并对BE黏膜发生肠上皮化生（IM）及异型增生的相关因素作初步探讨。方法回顾分析经胃镜下诊断的547例BE患者的临床和镜下特点,其中经病理确诊59例,分析其临床资料、胃镜表现、病理类型与IM及异型增生的关系。结果BE患者以男性居多,随年龄增长有增多趋势。部分患者存在不同程度的胃食管反流症状（GERD）,少数患者镜下有反流性食管炎（RE）表现。黏膜形态以岛状型多见,柱状上皮长度以短段为主。病理类型以胃底型及贲门型多见,显著高于特殊肠化生型。肠化生型BE上皮异型增生发病率显著高于另外两种病理类型。IM及异型增生在两性别间的发病率无统计学差异,30岁以上发病率显著高于30岁以下组。长段BE的IM及异型增生发生率高于短段BE,全周型及舌型发生率高于岛状型,但均无显著性差异。结论BE多发于男性、年长患者,是独立于RE及GERD的疾病。BE镜下以短段、岛状型多见。肠上皮化生少见,但此种类型的异型增生率高,是癌变的危险因素,需提高其检出率。     

内镜窄波成像Barrett食管上皮形态变化与病理结果的对照分析

[目的]探讨内镜窄波成像(NBI)下Barrett食管(BE)上皮形态变化特点与病理组织学诊断结果的符合率。[方法]选取胃镜检查疑诊为BE的102例患者,NBI模式下实时观测BE上皮形态变化特点,判断肠上皮化生类型,随后对所检查部位黏膜靶向活组织病理检查,分析两者诊断结果的相符率。[结果]91例患者被确诊为BE,NBI模式下根据小凹的形态特点分成规则无增粗型、规则增粗型、紊乱增粗型,与之相对应的为胃底腺型、贲门腺型、特殊肠上皮化生型,经靶向活组织病理检查后证实其准确度分别为85.7%、86.6%、88.4%。[结论]NBI可准确分辨BE上皮形态变化的组织类型,靶向活检提高组织病理学准确性,两者诊断符合率达≥85%。     

Barrett食管13例临床分析

目的 探讨Barrett食管（BE）的内镜表现、病理特征以及与食管腺癌的关系。方法 分析13例BE患者的临床表现、内镜诊断及病理特点。结果所有患者均有反酸、烧心感等症状，其中同时伴食管裂孔疝者3例，内镜下全周型2例、岛型7例和舌型4例。活组织病理检查均有柱状上皮化生。其中不典型增生1例，随访2年后发现癌变。结论 BE是反流性食管炎发展的一种结果，可导致食管腺癌，其诊断需内镜和活组织检查，药物治疗只能改善症状，应定期进行随访，发现恶变及早手术。     

胃粘膜肠上皮化生的内镜诊断

目的探讨内镜下胃粘膜肠上皮化生诊断的可行性及准确度.方法应用放大或普通型内镜对受检者的胃底、胃体及胃窦进行仔细观察,详细描述肠上皮化生的表现特点并至少于胃窦小弯、大弯及胃体各取活检一块,收集同期病理诊断肠化生的病例并将内镜表现与病理进行对照分析.结果同期病理组织学诊断肠上皮化生患者329例.根据内镜下的特异性肠上皮化生的表现淡黄色结节状、瓷白色小结状、鱼鳞状和弥漫不规则颗粒不平状,内镜诊断肠上皮化生134例,经活检病理证实128例,内镜诊断符合率95.5%.胃粘膜活检诊断而内镜未予诊断者201例,内镜检查诊断肠上皮化生的总符合率38.9%.轻、中、重度肠上皮化生内镜诊断率不同,分别为23.8%、48.5%和51.7%.而放大内镜对轻、中、重度肠上皮化生诊断准确率分别为47.5%、78.5%和75.4%,明显高于普通型内镜组的1.9%、28.6%和34.9%,(P＜0.05),差异有显著意义.结论胃粘膜肠上皮化生内镜表现除淡黄色结节型和粘膜不规则颗粒不平的弥漫型外,尚有鱼鳞状和瓷白色半透明的小结节型,这四种典型的肠上皮化生形态学特征,是内镜诊断肠化生的特异型标志.这四种肉眼形态学特征与病理肠上皮化生程度无关,但肠化生程度与内镜诊断呈平行关系.放大内镜对肠上皮化生诊断率明显高于普通型内镜.     

Barrett食管的内镜与病理特征分析

目的探讨Barrett食管（BE）的病理和内镜特点。方法对152例经胃镜榆查并经病理检查证实的BE患者资料进行回顾性分析、总结。结果BE患者以40—60岁居多。临床症状有不同程度重叠,烧心反酸51．32％（78／152）、吞咽困难5．92％（9／152）、胸骨后疼痛7．89％（12／152）、上腹痛或不适44．08％（67／152）,无症状者5．26％（8／152）。内镜下表现为LSBE者7例（4．61％）、SSBE者145例（95．39％）。可见岛型98例,占64．47％;舌型39例,占25．66％;全周型15例,占9．87％。病理检查152例食管下段复层鳞状上皮均被柱状上皮取代,68例（44．74％）有肠化。结论BE多见于中年人,临床无特殊表现,诊断依靠内镜和病理检查,以岛型多见,但岛型肠化率最低,年龄与肠化相关,伴异型增生和肠化患者应加强随访以防止癌变。     

Barrett食管的临床认识

Barrett食管(BE)是指食管下段复层鳞状上皮被化生的柱状上皮所取代的病理现象,是食管腺癌的癌前病变。BE在内镜下按化生柱状上皮的长度分为长段(≥3cm)和短段(3cm),亦可按布拉格的标准,即根据环周型的范围和最大长度进行分类。为证实化生上皮或肿瘤性病变的存在,应在内镜下活检,行病理检查。对不伴有异型增生的BE患者应每2年接受1次内镜复查,如果2次复查后未检出异型增生和早期癌,可以酌情将复查间隔放宽为3年,而对重度异型增生的BE,应考虑内镜下切除或外科治疗。     

Barrett食管诊治共识(草案)

一、Barrett食管的定义 Barrett食管（Barrett＇s esophagus，BE）是指食管下段的复层鳞状上皮被化生的单层柱状上皮所替代的一种病理现象．可伴肠化或无肠化。其中伴有特殊肠上皮化生属于食管腺癌的癌前病变。     

Barrett食管诊治共识（草案）

Barrett食管（barrett esophagus，BE）是指食管下段的复层鳞状上皮被化生的单层柱状上皮所替代的一种病理现象，可伴肠化或无肠化，其中伴有特殊肠上皮化生者属于食管腺癌的癌前病变。     

胃粘膜肠上皮化生的内镜分析

目的探讨内镜下胃粘膜肠上皮化生诊断的可行性及准确度。方法应用放大或普通型内镜对受检者的胃底、胃体及胃窦进行仔细观察，详细描述肠上皮化生的表现特点并至少于胃窦小弯、大弯及胃体各取活组织检查(简称活检)一块，收集同期病理诊断肠上皮化生的病例并将内镜表现与病理进行对照分析。结果同期病理组织学诊断肠上皮化生患者329例。根据内镜下的特异性肠上皮化生的表现淡黄色结节型、瓷白色小结节型、鱼鳞型和弥漫型，内镜诊断肠上皮化生134例，经活检病理证实128例，内镜诊断符合率95.5％。胃粘膜活检诊断而内镜未予诊断者201例，内镜检查诊断肠上皮化生的总符合率38.9％。轻、中、重度肠上皮化生内镜诊断率不同，分别为23.8％、48.5％和51.7％。而放大内镜对轻、中、重度肠上皮化生诊断准确率分别为47.5％、78.5％和75.4％，明显高于普通型内镜组 的14.9％、28.6％和34.9％，差异有显著性(P＜0.05)。结论胃粘膜肠上皮化生内镜表现除淡黄色结节型和弥漫型外，尚有鱼鳞型和瓷白色小结节型，这四种典型的肠上皮化生形态学特征，是内镜诊断肠上皮化生的特异型标志。这四种肉眼形态学特征与病理肠上皮化生程度无关，但肠上皮化生程度与内镜诊断呈平行关系。放大内镜对肠上皮化生诊断率明显高于普通型内镜。     

福建地区Barrett食管的发病情况和内镜及临床特点

目的研究福建地区Barrett食管(BE)的发病情况和内镜、临床特点及其与反流性食管炎(RE)的关系。方法根据新标准诊断BE,研究BE患者的内镜下检出率、内镜表现、分型及病理检查结果,分析患者的年龄、性别、症状、幽门螺杆菌(Hp)感染情况及其与RE的关系。结果检出BE为总胃镜检查人数的7.90%,男女之比为1.98,平均年龄(45.1±14.8)岁,仅19.15%有典型反流症状。BE中短节段占81.20%,多为舌状、岛状或包含这2种形状的混合型。食管活检组织病理诊断为肠化型占BE的34.83%,9.88%伴异型增生,胃窦Hp阳性率为39.94%。RE检出率为2.07%,比BE显著降低(P<0.01)。8.42%的BE伴RE,32.11%的RE伴BE。结论福建地区BE患病率较高,多为短节段舌状或岛状,约1/3为肠化型,以中年男性多见,常无症状,与RE无明显相关性,部分伴异型增生。BE的临床意义和预后有待于进一步研究。     

Barrett＇s esophagus： Prevalence and risk factors in patients with chronic GERD in Upper Egypt

AIM： To determine the prevalence and possible risk factors of Barrett＇s esophagus （BE） in patients with chronic gastroesophageal reflux disease （GERD） in EI Minya and Assuit, Upper Egypt. METHODS： One thousand consecutive patients with chronic GERD symptoms were included in the study over 2 years. They were subjected to history taking including a questionnaire for GERD symptoms, clinical examination and upper digestive tract endoscopy. Endoscopic signs suggestive of columnar-lined esophagus （CLE） were defined as mucosal tongues or an upward shift of the squamocolumnar junction. BF was diagnosed by pathological examination when specialized intestinal metaplasia was detected histologically in suspected CLE. pH was monitored in 40 patients. RESULTS： BE was present in 7.3% of patients with chronic GERD symptoms, with a mean age of 48.3 ± 8.2 years, which was significantly higher than patients with GERD without BE （37.4 ± 13.6 years）. Adenocarcinoma was detected in eight cases （0.8%）, six of them in BE patients. There was no significant difference between patients with BE and GERD regarding sex, smoking, alcohol consumption or symptoms of GERD. Patients with BE had significantly longer esophageal acid exposure time in the supine position, measured by pH monitoring. CONCLUSION： The prevalence of BE in patients with GERD who were referred for endoscopy was 7.3%. BE seems to be associated with older age and more in patients with nocturnal gastroesophageal reflux.     

Esophageal atresia: metaplasia,Barrett

Barrett's esophagus is characterized by the replacement of squamous epithelium by columnar epithelium that is intestinal metaplasia‐positive or ‐negative in the distal esophagus. Gastroesophageal reflux disease, which is frequent and prolonged in esophageal atresia, probably plays a major role in the development of Barrett's esophagus through repeated mucosal damage. Long‐term acid exposure contributes to carcinogenesis in Barrett's esophagus of intestinal type, but its effect on gastric metaplasia is less well defined. Recent studies have suggest that metaplasia arises in about 15% of patients with esophageal atresia, with a lag time to developing metaplasia from initial surgical correction of about 10 years. Preliminary data from an ongoing multicenter study including 88 patients with esophageal atresia aged 15–19 years showed gastric metaplasia in 42% of patients (29 fundic and 7 cardial metaplasia), while one patient presented intestinal metaplasia. Esophageal mucosal abnormalities can be observed in esophageal atresia patients at endoscopy despite the absence of symptoms. Whether prolonged, aggressive, acid suppression is beneficial in these situations remains to be determined. Barrett's metaplasia can be removed by endoscopic mucosal resection or destroyed with endoscopic ablative techniques, such as photodynamic therapy, radiofrequency ablation, and cryotherapy. The risk of developing esophageal carcinoma is still a controversial issue as only a few clinical cases have been reported in young adults with esophageal atresia. As late complications of esophageal atresia, particularly esophagitis and Barrett's esophagus, are increasingly being recognized, long‐time systematic follow up of the esophageal mucosa including multistage biopsies is therefore required even in asymptomatic patients.     

肠型巴雷特食管危险因素临床分析

目的探讨肠型化生巴雷特食管（BE）的相关危险因素。 方法收集2017年1月至2020年1月在新疆维吾尔自治区人民医院诊治的55例肠型BE和性别、居住情况匹配的110例非肠型BE患者的临床资料，对两组患者基本状况、生活习惯以及临床病理参数进行回顾性分析，对比分析两组患者临床资料差异性，利用Logistic回归分析筛选肠型BE发生、发展相关的危险因素。 结果本院肠型BE患者检出率为3.7%（55例），其中男性占56.4%（31例），女性占43.6%（24例），平均年龄为57.73±6.54岁。肠型和非肠型BE患者在年龄、体重指数（BMI）、是否伴有胃食管反流病（GERD）症状和食管裂空疝、是否有食管癌家族史、血清幽门螺旋菌（HP）感染状态以及按化生的柱状上皮长度分型差异有统计学意义（P＜0.05）；在吸烟、饮酒、咖啡因摄入、饮茶习惯、结肠腺瘤诊断史及BE和结直肠癌家族史等上均无统计学意义（P＞0.05）。年龄≥50岁（P=0.031，OR=3.027，95%CI：1.107-8.278）、BMI＞25 kg/m²（P=0.029，OR=2.300，95%CI：1.089-4.856）和食管癌家族史（P=0.020，OR=2.420，95%CI：1.152-5.084）是肠型BE的危险因素。 结论年龄≥50岁、高BMI以及食管癌家族史是BE，尤其是肠型BE的危险因素，应加强具有上述危险因素的高危人群的健康宣传和管理，注重消化系统内镜监测，防止其发展为恶性肿瘤。     

Barrett's esophagus in patients with symptomatic reflux esophagitis

We evaluated the frequency with which Barrett's esophagus (BE) occurs in patients with symptomatic reflux esophagitis, and compared the clinical endoscopic and manometric features of patients with Barrett's esophagus with those of patients who had non-Barrett's esophagitis (NBE). The effect of 6 months' medical treatment on BE patients was reevaluated by repeating manometry, endoscopy, and biopsy. Esophageal manometry was performed by perfusion technique and endoscopic biopsies were obtained. There were 180 patients; 20 (11%) were found to have BE. The vast majority of BE patients were caucasians. BE patients had symptoms of gastroesophageal reflux for a longer time than did NBE patients. Mean lower esophageal sphincter pressure in BE patients was lower than that in NBE patients. On medical treatment, the severity of esophagitis as judged by endoscopic criteria in BE patients was reduced, but there was no increase in lower esophageal sphincter pressure and no regression of the columnar epithelium.     

Detection of Barrett's esophagus after endoscopic healing of erosive esophagitis

BACKGROUND: The presence of erosive esophagitis (EE) in patients presenting for upper endoscopy may prevent the detection of underlying Barrett's esophagus (BE) in the distal esophagus. AIM: To prospectively determine the proportion of patients detected with BE upon repeat endoscopy after healing of EE. METHODS: Patients with endoscopically confirmed EE without BE were treated with standard doses of acid suppression therapy and a repeat endoscopy was performed to assess the presence of BE. If columnar mucosa was visualized in the distal esophagus, targeted biopsies were obtained and all biopsies were evaluated for the presence of intestinal metaplasia. BE was defined as columnar mucosa in the distal esophagus with intestinal metaplasia on biopsy. RESULTS: A total of 172 patients with reflux symptoms were diagnosed with EE without BE on initial endoscopy. They were treated with standard doses of proton pump inhibitor therapy, and after a mean duration of 11 wk (range 8-16 wk), a repeat endoscopy was performed to confirm healing of EE and to document the presence of BE. On repeat endoscopy, EE was completely healed in 116 patients (67%), and of those, BE was suspected in 32 patients (i.e., columnar-lined distal esophagus) and was confirmed in 16 patients (13.8%). In the 56 patients with persistent EE on repeat endoscopy, columnar mucosa in areas of previously healed esophagitis was visualized in 8 and confirmed in 5 patients (8.9% of nonhealed cases). Overall, 21 (12%) patients were confirmed with BE on repeat endoscopy; all men, mean age 61 yr with a median BE length of 0.5 cm (range 0.5-5 cm, interquartile range 0.5 cm). The majority of these patients (N = 19) had short segment Barrett's esophagus (SSBE) (i.e., length <3 cm). CONCLUSIONS: In patients with EE undergoing treatment with acid suppressive therapy, BE (mainly SSBE) is detected in approximately 12% of patients on repeat endoscopy. Patients with reflux symptoms undergoing endoscopy for the detection of BE (i.e., screening) should be treated with acid suppressive therapy prior to endoscopy to enhance the yield of BE. Alternatively, if the goal is to document BE and if EE is found at the initial endoscopy, then repeat endoscopy may be considered after acid suppressive therapy.     

短节段Barrett食管临床研究

目的探讨短节段Barrett食管(SSBE)的临床特征、诊治、随访及其可能发病机制。方法回顾分析52例经内镜和病理确诊的SSBE，重点为内镜特征、病理学改变、食管动力检查结果、内镜复查及疗效观察。结果SSBE内镜下以岛型最多见占86．5％，常规病理证实的特异型肠上皮化生占15．4％，11例患者行24h食管pH和胆汁联合监测及食管测压，72．7％存在异常。21例患者行氩离子凝固术等内镜介入治疗，短期内复查15例SSBE消退。49例复查胃镜者未发现食管癌变。结论SSBE发生与胃酸和胆汁反流相关，内镜下以岛型常见，其肠化生、不典型增生的发生率可能相对较低。