Endoscopic ablation of Barrett’s esophagus using the second generation argon plasma coagulation: a prospective randomized controlled trail

Objective:To investigate the efficacy and safety of the second generation argon plasma coagulation(VIO APC) in the ablation of Barrett’s Esophagus. Methods:A total of 35 patients with uncomplicated Barrett’s esophagus entered into a prospective, randomized, unblinded study comparing the treatment VIO APC combined with a proton pump inhibiter with a proton pump inhibiter administered alone. VIO APC was performed at a power setting of 40W, and argon gas flow at 1.5-2.0 L/min, and“forced”mode. Ablative treatment was repeated until either no Barrett’s epithelium remained or a maximum of 5 treatment sessions occurred. Results:In the ablation group, macroscopic complete ablation was achieved in 14 of 18 patients, and complete ablation confirmed by histology in 12 of 18 patients(P < 0.01). Buried glands were observed in 2 patients who had achieved macroscopic ablation. The Barrett’s mucosa averaged a reduction of 65%(range 50-75%) in the remaining 4 patients. In the control group, only 2 patients had partial regression, median 30%(range 20-40%). In the ablation group, post-treatment 4 patients had transient retrosternal pain, and 3 patients had mild epigastric discomfort. One patient had a small hemorrhage during the procedure, which ceased after norepinephrine and thrombosin were administered through the endoscope biopsy channel. No adverse events were observed in the control group. During 11.8(4-15) months follow-up, patients who had achieved the complete ablation have no evidence of relapse of Barrett’s esophagus. Conclusion:VIO APC with a relatively low power setting can effectively ablate the Barrett’s mucosa. No severe adverse events were observed. Long-term follow-up is needed to assess cancer prevention and the durability of the neo-squamous epithelium.     

高频电治疗Barrett’s食管30例

目的探讨高频电治疗Barrett’s食管的疗效。方法对无异型增生的BE患者行热探针治疗,有异型增生的BE患者行内镜下黏膜切除。结果全部患者肉眼观察均修复为正常的鳞状上皮,组织学仅有3例（10%）残存特殊柱状上皮,随访3～6个月复发4例（13%）,并发症轻微短暂。结论高频电治疗BE安全、方便、有效。     

Barrett’s食管内镜检出率及临床分析

胃食管反流病是消化系统常见病，而Barrett’s食管是胃食管反流性疾病的一个并发症，也是食管腺癌发生的危险因素，内镜检查是有效的诊断方法，以往由于对Barrett’s食管重视不够，Barrett’s食管内镜检出率的报道不多，现将我院2003年1月-2006年1月内镜诊断的Barrett’s食管进行总结分析。     

江苏地区Barrett’s食管患病率的内镜研究

目的探讨江苏地区接受内镜检查的人群中Barrett’s食管（BE）患病率及其变化趋势,以及同期同人群中食管腺癌的患病情况。方法以我院近4年接受内镜检查的患者为研究对象,对内镜疑诊的BE患者取活检,病理标本见到真性杯状细胞确诊为BE。分别研究4年间BE的总体患病率、各年度病例患病率及各年龄组患病率,同时研究BE的内镜下形态和同期食管腺癌的患病情况。结果上消化道内镜检查的69544例中,共检出BE105例,BE的总体患病率为1．51‰（95％CI1．27‰～1．75‰）,其中男性和女性分别为55例及50例,两者在平均年龄和患病率间均无差异。近四年的年度病例患病率分别为2．15‰、1．23‰、1．41‰及1．39‰,各组间差异无显著性（P=0．18,X2=4．92）。随着年龄增长,BE的患病率呈逐渐增加的趋势,且各个年龄组间患病率差异有显著性（X2=6．07,P〈0．01）。除典型的内镜下表现外,部分BE患者可表现为食管炎、食管溃疡等。BE的内镜下形态以岛形最多见（51．35％）,舌形次之（35．14％）,全周形最少（13．51％）。食管腺癌占同期所有食管癌的比例仅为4．68％,且近四年该比例并未明显升高。结论近4年江苏地区所有接受上消化道内镜检查者中BE总体患病率约为1．51‰,该比例在过去四年间并没有明显升高,但随着年龄增长其患病率逐渐增加。食管腺癌占所有食管癌的比例仍很低且相对稳定。     

Lugol’s液食管染色对Barrett食管的诊断价值

目的探讨Lugol’S液进行食管染色对Barrett食管的诊断价值。方法检查前确认患者无碘过敏史,对胃镜下初步诊断为Barrett食管的患者,随机分为两组,对照组（20例）,在紧靠齿状线下方、齿状线舌形突出、齿状线上岛形橘红色黏膜处取活检2～4块,送病理检查;实验组（24例）行2％Lugol’s液10～20mL食管染色,1～3min食管黏膜着色,在食管不着色区取活检2～4块送病理检查。结朵对照组确诊Barrett食管12例,其中3例为肠化型Barrett食管,实验组诊断为Barrett食管18例,其中7例为肠化型,实验组BE的检出率明显高于对照组（Х^2=4．4,P〈0．05）。结论Lugol’s液食管染色结合靶向活检可以提高Barrett食管的诊断率。     

Microsurgical treatment of Nelson’s syndrome

Objective To discuss the etiology, diagnostic criteria and treatment of Nelson’s syndrome.Methods Twenty-three patients with Nelson’s syndrome who were treated in our department over the last 19 years were analyzed retrospectively.Removal of adenoma by the transsphenoidal approach was done in 21 patients and by transfrontal craniotomy in 2.The follow-up period ranged from six months to nine years.Results The incidence of Nelson’s syndrome was 7.7% in a series of 300 patients with Cushing’s disease treated by microsurgery in the same period.Hyperpigmentation was relieved and adrenocorticotropic hormone (ACTH) levels decreased in all patients after tumor excision.Eight patients with visual disturbance improved after surgery.The curative and remission rates were 56.5% and 26.1%, respectively.Conclusions Transsphenoidal microsurgical removal of pituitary ACTH adenoma is the first choice in the prevention and treatment of Nelson’s syndrome.Regular follow-up examinations should be performed over a long time.     

Parkinson’s disease therapy: treatment of early and late disease

Purpose To summarize the current strategies for the treatment of early and late Parkin son’s disease (PD).Data sources The presented guidelines are based on the review of the literature as well as th e author’s extensive experience with the treatment of 7000 patients with PD over the past 25 years.Results An analysis of reported data as well as personal experience suggest that while y oung patients seem to have a slower progression of the disease, they are at a hi gher risk for developing levodopa induced complications, such as motor fluctuati ons and dyskinesias. It is, therefore, prudent practice to delay levodopa thera py, particularly in younger patients, until the PD symptoms become troublesome a nd interfere with social or occupational functioning. Other strategies, such as the use of deprenyl, amantadine, trihexyphenidyl and dopamine agonists, should be employed before instituting levodopa therapy. Entacopone and dopamine agonis ts are useful in smoothing out levodopa related motor fluctuations. Surgical in terventions, such as pallidotomy and pallidal or subthalamic deep brain stimulat ion, are effective therapeutic strategies, but should be reserved only for patie nts in whom optimal medical therapy fails to provide satisfactory control of sym ptoms.Conclusion The medical and surgical treatment of patients with PD must be individualized an d tailored to the needs of the individual patient.     

Analysis of the association of serum uric acid levels with the progression of Parkinson’s disease in Chinese patients

Background/Aims: Uric acid (UA) is suspected to play a neuro-protective role in Parkinson’s disease (PD). This study aims to evaluate whether the serum UA level is associated with the disease progression of PD in a relatively large population of Chinese patients. Methods: Serum UA levels were measured from 399 Chinese PD patients and 387 age-matched controls; following the uric acid colorimetric method, the serum creatinine (Scr) levels were also measured to reduce the bias caused by possible differences in renal excretion function. The disease severity was scored by Hoehn and Yahr (H&Y) Scales and disease durations of PD; and the associations between serum UA level and disease progression were analyzed. Results and conclusion: PD patients were found to have significantly lower levels of serum UA than controls (249.31±79.48vs283.78±103.30, umol/). Stratified analysis showed a similar PD progression rate in both men and women. There was a significant inverse correlation of UA levels with H&Y Scales (Rs=-0.421, p<0.01) and disease duration (Rs=-0.239, p<0.01) of PD patients of both females and males. No difference of the Scr levels between PD patients and controls was found (72.09±15.64vs69.93±19.59, umol/L). Our data suggest that lower serum UA levels may possess higher risk of PD, which may be a useful biomarker to indicate the progression of PD.     

Association of serum uric acid levels with the progression of Parkinson’s disease in Chinese patients

Background  Uric acid (UA) is suspected to play a neuro-protective role in Parkinson’s disease (PD). This study aimed to evaluate whether the serum UA level was associated with the disease progression of PD in a relatively large population of Chinese patients.

Methods  Serum UA levels were measured from 411 Chinese PD patients and 396 age-matched controls; following the uric acid colorimetric method, the serum creatinine (Scr) levels were also measured to reduce the bias caused by possible differences in renal excretion function. The disease progression was scored by Hoehn and Yahr (H&Y) scales and disease durations; PD group was divided into 3 subgroups according to H&Y scales. Independent-samples t test was performed to analyze the differences between PD group and control group. Multiple analysis of covariance was performed to analyze the differences between PD subgroups. Spearman rank-correlation was performed to evaluate the associations between serum UA or Scr level and disease progression.

Results  PD patients were found to have significantly lower levels of serum UA than controls ((243.38±78.91) vs. (282.97±90.80) µmol/L, P <0.01). As the disease progression, the serum UA levels were gradually reduced. There was a significantly inverse correlation of UA levels with H&Y scales (Rs= –0.429, P <0.01) and disease duration (Rs= –0.284, P <0.01) in PD patients of both females and males. No significant difference of the Scr level between PD patients and controls was found ((70.01±14.70) vs. (69.84±16.46) µmol/L), and the Scr level was not involved in disease progression.

Conclusion  Lower serum UA levels may possess a higher risk of PD, which may be a potential useful biomarker to indicate the progression of PD.

     

Barrett食管的内镜治疗进展

Barrett食管是食管腺癌的癌前病变,其发展为食管腺癌的风险较普通人明显增高。目前主要的治疗方式有药物抑酸治疗、外科手术行食管切除和内镜下治疗。由于抑酸治疗的局限性、食管切除手术本身的高风险、术后诸多并发症、高费用等因素,以及随着近10余年来消化内镜的飞速发展和普及,内镜下治疗Barrett食管变得越来越普遍,也成为了研究的热点。该文就Barrett食管治疗方式的原理、疗效、安全性等方面进行综述。     

内镜下氩离子凝固术治疗Barrett食管12例分析

目的 探讨内镜下氩离子凝固术(APC)治疗Barrett食管(BE)的临床价值.方法 选择本院2006年5月-2008年10月经胃镜检查、病理证实的12例BE患者进行60W APC治疗,术后予埃索美拉唑辅助治疗,对其疗程、疗效、并发症进行评估.结果 12例均完成治疗,10例仅需1次APC治疗即获得消除,2例需2次治疗.8例治疗期间有轻度并发症,为胸骨后疼痛,口服埃索美拉唑1周内症状改善.结论 APC是一种安全、有效的治疗BE的方法.     

Barrett食管(BE)的内镜和临床特征

目的探讨宁夏地区BE的内镜检查特点和临床特征。方法依据2005年重庆BE诊断标准和1994年洛杉矶反流性食管炎(RE)诊断标准诊断BE和RE,分析BE和RE患者的年龄、性别、症状、内镜和病理特征的异同及其与RE的关系。结果BE检出率为2.78%,男女之比为1.42:1,40岁以上占73.86%。BE有典型反流症状比RE显著为少(P<0.05)。BE常见主诉为上腹痛或不适。SSBE较LSBE更多;岛型为主。食管病理活检为肠化型者占20.18%,异型增生者占11.01%。BE伴食管炎症程度为A级 B级的占80.00%。BE和RE病理活检均未见食管癌。结论宁夏地区BE检出率较高,40岁以上检出率明显增多。多为SSBE,以岛型为主。BE患者的临床症状与其胃镜下的食管黏膜改变并不完全一致。BE可能是一种独立的疾病。     

关于Barrett食管诊断的临床探讨

Barrett食管（Barrett’s Esophagus BE）是唯一公认的食管腺癌癌前病变。BE患者较正常人群患食管腺癌的危险性增加30倍～50倍。但由于BE位置结构的特殊性，临床上易漏诊、误诊，使一部分患者失去早期治疗机会。现对2002年3月至2006年3月在我院行胃镜检查并由病理确诊的BE病例的发病特点、常规镜下表现进行分析总结，以提高诊断水平。     

Characteristics of Acid Reflux in Blarrett‘s Esophagus

Barrett's esophagus is a precancerous condi-tion in which the squamous mucosa of the esopha-gus is replaced by columnar epithelium.Patientsunder this condition are at greater risk for the de-velopmentof esophagealadenocarcinoma.Barrett'sesophagus is an acquired condition resulting fromlongstanding gastroesophageal reflux disease[1] .But only approximately1 0 % of patients with re-flux esophagitis develop Barrett's esophagus.Thisstudy analyzed the correlation of acid reflux withreflux esophagi…     

共聚焦激光显微内镜对Barrett食管诊断价值的研究

目的 观察Barrett食管在共聚焦激光显微内镜下的形态学特征,评价共聚焦激光显微内镜对Barrett食管的诊断价值.方法 选取普通胃镜检查疑诊Barrett食管的患者,进行共聚焦激光显微内镜检查.对可疑或病变部位进行共聚焦内镜扫描,检查后即刻进行预测组织学诊断,即共聚焦激光显微内镜诊断.最后对扫描部位黏膜活检,将共聚焦激光显微内镜诊断与病理组织学诊断进行对比分析.结果 对入选的23例患者的73个部位进行共聚焦激光显微内镜扫描,结果显示共聚焦激光显微内镜诊断Barrett食管的灵敏度为95.6%,特异度为96.4%,阳性预测值为97.7%,阴性预测值为93.1%,诊断符合率为95.9%.结论 共聚焦激光显微内镜可以在内镜检查同时快速准确的诊断Barrett食管.     

Barrett's食管组织中环氧合酶-2的表达及食管动力学测定

目的:探讨Barrett's食管(BE)食管运动功能、环氧合酶-2(COX-2)的表达及其发病机制。方法:收集62例经内镜和病理确诊的BE患者的资料,对其中21例的食管动力学检查结果进行分析;采用免疫组化SP法检测其中37例食管黏膜组织中COX-2蛋白的表达。以20例同期健康体检者和23例反流性食管炎(RE)患者作对照。结果:BE组下食管括约肌(LES)压力低于RE组及健康对照组,BE组食管远端收缩波幅较RE组及对照组降低(P均<0.05),而食管近端收缩波幅3组间差异无统计学意义(P>0.05)。正常十二指肠上皮组织中COX-2无表达,而20/24无不典型增生BE肠化黏膜、12/13不典型增生BE肠化黏膜表达COX-2蛋白,且2者间表达差异无统计学意义(P<0.05)。结论:LES功能失调是BE主要发病机制,COX-2蛋白的表达是BE发生的早期事件。     

大鼠反流性食管炎和Barrett食管基因表达谱的比较

目的:研究Barrett食管(BE)和反流性食管炎(RE)组织基因表达谱的差异. 方法: 建立胃十二指肠混合食管反流SD大鼠动物模型,用含有4096条双点大鼠cDNA芯片分别比较BE,RE和正常食管上皮(NC) mRNA表达情况. 结果: 芯片杂交差异表达在3倍以上的基因,RE和NC杂交芯片232项,其中表达上调的基因90条,表达下调的基因142条;BE和NC杂交芯片448项,其中表达上调的基因312条,表达下调的基因136条;相对于RE,BE表达上调的基因214条,表达下调的基因86条. 结论: BE和RE在基因表达水平上存在差异.     

食管炎、食管溃疡和Barrett's食管的胃-食管反流与胃内pH值的关系

目的 探讨胃内pH值与胃食管反流的关系及胃-食管反流的病理生理机制.方法 采用便携式pH监测仪对18例食管炎、12例食管溃疡、10例Barrett's食管、15例健康人行24h食管和胃pH值同步监测,分别计算胃内各段pH值、胃-食管酸反流次数、长反流次数、最长反流时间以及pH值<4的时间占总时间的百分比.结果 ①食管炎组:上述各项指标在胃内pH值为1～4时明显高于对照组(P<0.05);当胃内pH值为1～2时,酸反流次数明显高于其他pH值段(P<0.05);②食管溃疡组:当胃内pH值为1～2时,酸反流次数、长反流时间明显高于其他pH值段(P<0.05);胃内pH值为1～3时,酸反流次数、长反流时间明显高于对照组(P<0.05);③Barrett's食管组:胃内pH值为2～3时的酸反流次数明显高于对照组;④当胃内pH值为1～2时,食管炎组、食管溃疡组酸反流次数明显高于Barrett's食管组.结论 当胃内pH值在1～2之间时,食管炎、食管溃疡的胃食管酸反流最为明显,食管黏膜损伤的严重程度与食管接触酸的次数及接触酸的时间长短有关;Barrett's食管的胃-食管酸反流与胃酸无明显关系.