反流性食管炎、Barrett食管的食管动力学研究

目的 探讨反流性食管炎(RE)、Barrett食管(BE)的动力学改变。方法 经内镜检查3 400例患者,分 RE、BE、对照组,进行症状调查、食管测压、食管24h pH检测,并行统计学分析。结果 RE与BE组间除吞咽不适外,烧心感、反酸及胸骨后疼痛的症状评分均为RE组大于BE组,且差异有显著性意义。部分RE、BE、对照组间食管运动功能比较,食管下括约肌静息压等差异均无显著性意义。食管24 h pH检测DeMeester评分、pH<4总时间、pH<4时间的百分比等 RE、BE组高于对照组,差异有显著性意义,但RE、BE组间差别无显著性意义。结论 食管反流症状与食管黏膜的内镜下表现不一致;食管组织化生与食管运动功能间无相关。     

Ki-67在Barrett食管、重度反流性食管炎和食管腺癌中的表达和意义

背景：Barrett食管是一种食管腺癌癌前病变。Ki-67是一种能较准确地评估细胞增殖状态的抗原，在肿瘤进程中可能起重要作用。目的：研究Ki-67在Barrett食管、重度反流性食管炎和食管腺癌中的表达和意义。方法：应用免疫组化SP法测定59例Barrett食管、5例重度反流性食管炎、5例食管腺癌和10例正常食管黏膜组织中Ki-67的表达。结果：Ki-67在重度反流性食管炎中的阳性率为80．0％，Barrett食管阳性率为76．3％，与正常食管黏膜组织（20．0％）相比有显著差异（P〈0．05）：食管腺癌阳性率为100％。Ki-67的表达随Barrett食管肠化生程度的加重而增高（P〈0．05）；而不同长度（短段、长段）、肠化生黏膜形态（全周型、舌型和岛型）以及不同程度（轻度、中度）异型增生的Barrett食管，Ki-67的表达均无显著差异（P〉0．05）。结论：Ki-67在重度反流性食管炎和Barrett食管中表达增强，提示其在食管腺癌进程中起重要作用。     

Barrett食管、反流性食管炎和非糜烂性胃食管反流病的反流物特点

目的应用食管24 h pH-阻抗(MII-pH)等检查方法,分析具有胃食管反流病(GERD)典型症状、并且食管MII-pH检查结果异常的GERD患者,比较分析其各亚型,即Barrett食管(BE)、反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者的胃食管反流特点。 方法入选具有典型胃食管反流症状(烧心/反流),并且食管24 h MII-pH检查结果异常的GERD患者,根据内镜检查结果分为BE、RE、NERD三组,收集患者24 h的食管pH-阻抗信息,应用SPSS16.0统计软件进行组间Mann Whitney检验、多因素方差分析,P< 0.05认为具有统计学差异。 结果共入组103例具有典型反流症状且MII-pH监测阳性的GERD患者,其中有15例BE患者、32例RE患者、56例NERD患者。三组患者的平均年龄、性别构成、以及BMI无显著差异性。将三组患者的各项胃食管反流指标数值进行Mann-Whitney检验,显示RE、BE患者的DeMeester评分、pH<4反流时间百分比、长反流周期数显著高于NERD患者,具有显著性差异。BE患者的反流周期数显著多于RE和NERD患者,具有显著性差异。阻抗相关指标在三组患者之间均没有统计学差异。 结论与NERD相比,酸反流对于RE和BE具有更重要的致病意义。     

Cdx2和MUC2在反流性食管炎、Barrett食管和食管腺癌中的表达

目的研究Cdx2和MUC2在反流性食管炎、Barrett食管和食管腺癌中表达，探讨3种食管黏膜疾病的内在关系。方法选取反流性食管炎30例、Barrett食管18例及食管腺癌25例作为研究对象，以正常食管上皮黏膜25例作为对照，采用免疫组化方法检测Cdx2和MUC2的表达，对结果进行统计分析。结果Cdx2和MUC2在反流性食管炎、Barrett食管及食管腺癌中的蛋白阳性表达率均较正常对照组明显增高（P〈0．05）。Cdx2在正常食管黏膜上皮中无表达，在反流性食管炎、Barrett食管及食管腺癌中的阳性表达率分别为26．7％、66．7％和28．0％，在Barrett食管中表达明显高于反流性食管炎（P〈0．05），亦明显高于食管腺癌（P〈0．05）；MUC2在正常食管黏膜上皮和反流性食管炎组织无表达，在Barrett食管及食管腺癌中的阳性表达率分别为61．1％和24．0％，Barrett食管中表达率明显高于食管腺癌（P〈0．05）。两者表达情况相似。结论Cdx2是肠上皮化生的始动因素，MUC2的表达是肠上皮化生的晚发事件。Cdx2和MUC2在反流性食管炎、Barrett食管和食管腺癌组织中的表达情况支持这3种食管黏膜疾病间有密切的关系。     

反流性食管炎、Barrett食管和食管腺癌中上皮钙粘蛋白的表达

目的：研究反流性食管炎（ＲＥ）,Ｂａｒｒｅｔｔ食管（ＢＥ）及食管腺癌（ＥＡＣａ）中上皮钙粘蛋白（Ｅ－ｃａｄｈｅｒｉｎ）的表达及其意义。方法：运用免疫组化法ＡＢＣ法检测了１３例ＲＥ,１７例ＢＥ,１１例ＥＡＣａ以及３０例正常食管粘膜（ＮＥ）中Ｅ－ｃａｄｈｅｒｉｎ的表达。结果：Ｅ－ｃａｄｈｅｒｉｎ在ＮＥ,ＲＥ,ＢＥ,ＥＡＣａ中表达呈逐渐降低趋势。     

反流性食管炎与食管腺癌

食管腺癌（EAC）的发病率在西方国家以年均10％的速度递增,其恶性程度较高,较早出现淋巴结转移,预后很差。在我国,随着生活水平的提高和生活方式的改变,食管腺癌的发病率亦呈现出升高的趋势。胃食管反流导致的食管黏膜慢性炎症是食管腺癌发生的重要危险因素。伴随食管反流的患者发展为腺癌的风险提高了2～7倍,且患癌风险与反流症状的严重程度和持续时间密切相关。     

胃食管反流与反流性食管炎

胃食管反流(gastroesophageal reflux,GER)主要由于食管下端括约肌(lower esophagealsphincter,LES)松弛,引起胃内容物反流入食管下段。这种现象可属生理性,常于正常人餐后出现,但因反流量不多,时间短暂,反流物即被清除回至胃内,并不致病。当有 LES 功能不良,导致频繁的 GER,量多且较持久时,可损伤食管下段粘膜而形成反流性食管炎,并能产生食管溃     

Barrett食管、糜烂性食管炎和非糜烂性反流病食管酸暴露及食管动力学分析

目的分析胃食管反流病(GERD)三种亚型Barrett食管(BE)、糜烂性食管炎(EE)和非糜烂性反流病(NERD)患者食管24 h pH监测与高分辨率食管测压结果,探讨不同亚型胃食管反流病食管酸暴露及动力学变化特点。 方法收集2015年12月至2017年12月,新疆维吾尔自治区人民医院接受住院治疗的90例GERD患者的临床资料,其中BE组28例、EE组35例、NERD组27例,通过食管24 h pH监测结果评价患食管酸暴露及反流特点,高分辨率食管测压检查评价食管动力学特点。 结果3组患者年龄及身体质量指数(BMI)等一般资料比较,差异无统计学意义(P>0.05);EE组患者24 h食管pH监测中pH≤4(酸反流)、40.05);3组Demeester评分比较,差异无统计学意义(P>0.05);LES长度3组无明显差异,BE组LES静息压及残余压较EE组和NERD组稍高,但差异无统计学意义(P均>0.05);3组在食管远端收缩积分比较,差异无统计学意义(P>0.05)。 结论食管测酸检查在GERD临床亚型的鉴别方面并无显著差别;Barrett食管、糜烂性食管炎、非糜烂性反流病均存在抗反流屏障功能减退,但不同程度的食管粘膜损伤对食管动力学的影响并无差异。     

Barrett食管与反流

目前大多数学认为Barrett食管（Barrett＇s esophagus，BE）的发生是胃食管反流造成食管下段黏膜的适应性变化，是反流性食管炎的常见并发症之一。正常人偶尔也可以出现反流，但时间甚短，主要于餐后发生，不足以造成食管黏膜的损伤，属于生理性反流；但当各种原因造成食管黏膜暴露于酸及胆汁的时间过长，就会导致食管黏膜的破损．出现糜烂、溃疡，久而久之就发生食管黏膜的移位。引起齿状线的上移。     

加强对胃食管反流病几个热点问题的研究

胃食管反流病（GERD）是一种常见胃肠道疾病。近年研究进展，尤其是内镜下食管炎的洛杉矾分类、蒙特利尔GERD全球定义和分类以及Barrett食管的布拉格C＆M分类标准，使我们对该病的认识逐步深入，但仍有诸多问题有待进一步研究。内镜下“微小病变”食管炎的诊断、非糜烂性反流病（NERD）的特点及其与功能性烧心的鉴别、非酸性反流的检测及其意义以及Barrett食管的诊断和治疗均为今后研究的热点。     

Cell Kinetic Study on Histogenesis of Barrett's Esophagus Using Rat Reflux Model

Background: To elucidate the histogenesis of Barrett's esophagus and esophageal adenocarcinoma, we designed a duodeno-gastric reflux model in which normal stomach function and normal nutritional status are retained. Methods: Male Wistar rats were used in the experiment. The esophago-gastric junction was side-to-side anastomosed to a loop of jejunum about 3 &#114 cm distal to Treitz's ligament. The animals were not exposed to any known carcinogens during the experiment. Sequential morphological changes were studied for up to 50 weeks after surgery. Serial sections were made and stained with hematoxylin and eosin (H&E). In addition, immunohistochemical staining for bromodeoxyuridine (BrdU) was performed along with histochemical staining for mucins using paradoxical concanavalin A (ConA), galactose oxidase Schiff (GOS), and high-iron diamine-alcian blue (HID-AB). Results: Severe esophagitis with squamous cell hyperplasia was noted in all animals after surgery. At week 20 after surgery, glandular metaplastic cells positive for ConA first appeared within the basal cell layer of esophageal squamous cell epithelium, and then GOS-positive cells and HID-AB goblet cells appeared. This is a characteristic of the specialized columnar epithelium of Barrett's esophagus. We detected esophageal adenocarcinomas in 1 out of 8 subjects at week 40 and in 3 out of 8 subjects at week 50 after surgery. Conclusions: Reflux of duodenal contents causes specialized columnar epithelium of Barrett's esophagus and esophageal adenocarcinoma. As part of the sequence of events leading to the development of Barrett's esophagus, pyloric-foveolar metaplasia was observed followed by the appearance of intestinal goblet cells. The pyloric-foveolar metaplasia appears to be associated with chronic mucosal damage and regeneration. This multiplastic cell lineage is referred to as 'gut-regenerative cell lineage' (GRCL).     

Evaluation of Esophageal Motility by Endosonography Using a Miniature Ultrasonographic Probe in Patients with Reflux Esophagitis

Background: Although there are several established methods used to evaluate esophageal motility, none allows for direct observation of esophageal wall motion. Esophageal dysmotility is thought to contribute to reflux esophagitis (RE). The aim of this study was to evaluate esophageal wall motility by endosonography using a miniature ultrasonographic probe (MUP) in patients with RE. Methods: The subjects consisted of 10 healthy controls (10 men with a mean age of 31.5 years) and 9 patients with RE (4 men and 5 women with a mean age of 51.5 years). High-frequency endoluminal sonography was performed using a 20-MHz transducer through a 16F gastric tube to evaluate esophageal wall motion. Four sonographic phases of an esophageal peristaltic sequence were identified. In the resting phase, the esophageal wall was in direct contact with the transducer. In the passive distention phase, the esophageal lumen was stretched maximally; in the contraction phase, it contracted; and in the relaxation phase, it returned to baseline. The baseline thickness of the muscle layers of the esophageal wall was measured at rest. The width decreased during the passive distention phase, increased and reached a maximum during the contraction phase, and returned to baseline during the relaxation phase. Results: The contractility index of the circular smooth muscle (CSM) in the distal esophagus and of the longitudinal smooth muscle (LSM) in the proximal esophagus were significantly lower in patients with RE. The duration of contraction in the distal esophagus was significantly longer in RE. Conclusions: We used a MUP to demonstrate abnormalities in esophageal wall motility in patients with RE. We conclude that the MUP is a potentially useful technique for evaluating esophageal dysmotility.     

老年人反流性食管炎及Barrett食管的发病情况和内镜临床特点

目的 研究老年人反流性食管炎(RE)及Barrett食管(BE)的发病情况、内镜临床特点及相互关系.方法 根据中国反流性食管病(炎)试行方案诊断RE,根据BE共识(2005重庆)诊断BE,研究老年人中RE及BE患者的内镜下检出率、内镜表现、分型,分析患者的性别、幽门螺杆菌(Hp)感染情况及RE与BE的关系.结果 老年人行胃镜检查的患者中RE检出率为3.18%,BE检出率为9.12%,前者显著较低(P＜0.01),男女之比分别为2.72、1.95,有典型反流症状者分别占45.21%、36.12%.RE中90.16%为轻中度(Ⅰ、Ⅱ级),BE中短段者占83.38%,多为舌状、岛状或包含这2种形状的混合型.活检病理检查发现伴不典型增生者RE中为18.52%、BE中为20.80%,多为轻中度.胃窦Hp阳性率RE患者为39.13%,BE患者为37.94%.7.70%的BE伴RE.结论 老年人RE及BE患病率均较高,男性均多见,RE多为轻中度,BE多为短节段舌状或岛状,近半数患者无典型反流症状,RE与BE相关性不明显.老年人RE及BE的高检出率值得重视.