有关Barrett食管的综合思考

Barrett食管作为发生食管腺癌的最主要因素已经引起较多学者的注意。此文将从定义、病因及发病机制、临床表现、诊断、治疗和预防等方面进行综述,同时也将近几年的国内外研究成果进行阐述。     

对Barrett食管的再认识

早在1937年,Lyell已注意到在食管鳞状上皮内有柱状上皮的存在;1950年,Barrett从解剖食管溃疡上证实了Lyell的发现,但认为这种改变是食管裂孔疝所致,将此类上皮称为Barrea食管（BE）。目前普遍的看法是BE的单层柱状上皮可伴肠化或无肠化。其中伴有特殊肠上皮化生者通常认为是食管腺癌的癌前病变。随着生活条件的改善和在胃部疾病中广泛采用的抗幽门螺杆菌治疗,食管鳞癌与胃体、胃窦癌的发病率日见下降,但食管部的腺癌与胃食管交界部的肿瘤却有增高的趋势。     

Endoscopic management of Barrett esophagus

Endoscopy has a vital role in the diagnosis, screening, surveillance and treatment of Barrett esophagus. Over the past few decades, tremendous advances have been made in endoscopic technology, and the management of dysplasia and early cancer in Barrett esophagus has changed radically from being surgical to organ-sparing endoscopic therapy. Proper endoscopic techniques and systematic biopsy protocols improve dysplasia detection, and endoscopic surveillance improves outcomes in patients with Barrett esophagus and dysplasia. Endoscopic treatment can be tissue acquiring (as in endoscopic mucosal resection and endoscopic submucosal dissection) or ablative (as with photodynamic therapy, radiofrequency ablation and cryotherapy). Treatment is usually multimodal, combining endoscopic resection of visible lesions with one or more mucosal ablation techniques, followed by long-term surveillance. Such treatment is safe and effective. Shared decision-making between the patient and physician is important while considering treatment for dysplasia in Barrett esophagus. Issues such as durability of response, importance of subsquamous Barrett epithelium and the optimal management strategy in patients with low-grade dysplasia and nondysplastic Barrett esophagus need to be studied further. Development of safer wide-field resection techniques, which would effectively remove all Barrett esophagus and obviate the need for long-term surveillance, is needed.     

老年人Barrett食管

食管粘膜呈粉红色,而胃粘膜呈橘红色,两者在食管下端贲门部相连,其衔接处参差不齐呈齿状,被称为齿状线或“Z”线。在返流性食管炎中常见齿状线上移,即所谓Barrett食管（Barrett’s esophagus,BE）。     

Barrett esophagus as precancerous lesion]

The incidence of Barrett's esophagus is still little known. Our objective has been to study the incidence of this lesion in our environment as well as the frequency of malignant degeneration in our endoscopic material. Among 12,450 upper digestive endoscopies done in the past 7 years, 945 instances of peptic esophagitis have been diagnosed (7.59%). Among them, 172 cases of endobrachiesophagus (Barrett's esophagus) were detected (1.38% of the entire endoscopy series and 18.2% of all cases of esophagitis). Twenty two of th 172 patients with Barrett's esophagus were diagnosed as having carcinoma (12.79%). Barrett's esophagus is a frequent complication of peptic esophagitis and as the possibilities of malignant changes are as high as 12.79 it should be considered as a precancerous lesion and monitored as such.     

Barrett食管化学预防机制研究进展

Barrett食管(BE)是胃食管反流病(GERD)的一种并发症,与食管腺癌密切相关。随着GERD发病率的增高,BE、食管腺癌的发病率也逐年增高。胃食管反流、酸暴露是重要的的发病因素,由于环氧合酶-2(COX-2)在BE、食管腺癌的早期高表达使得非甾体类消炎药(NSAID)及选择性COX-2抑制剂在BE的化学预防方面显得尤其重要。     

Barrett esophagus in sexagenarian identical twins

Identical twins presented as sexagenarians with heartburn, regurgitation, and dysphagia; each had a Barrett esophagus remarkably similar to the other. This instance suggests a hereditary influence upon the development of mucosal dysplasia in some patients with this condition.     

Endoscopic imaging of Barrett’s esophagus

The incidence of esophageal adenocarcinoma(EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett’s esophagus(BE),a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC,GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE.     

Barrett食管和食管腺癌的基因表达谱研究

目的:研究Barrett食管(BE)和食管腺癌的基因表达谱,筛查与食管腺癌相关的基因.方法:使用Dchip软件对已经在GEO数据库中公开的BE和食管腺癌Affymetrix芯片表达谱数据进行分析.还原扫描图像进行独立核验,并对基因和组织进行双向聚类,最后用配对t检验筛查出在BE和食管腺癌中表达水平都发生变化的基因,并进一步分析其功能.结果:24张Affymetrix芯片的杂交质量稳定,被污染和发生交叉杂交的探针簇都少于5%.对基因和样本的双向聚类表明,大部分组织分类正确.只有N8和A5位于错误的组织类型中.对其余22张芯片再次分别进行配对t检验,得到24个基因.其中表达水平呈进行性上升的5个,呈进行性下降的19个.新检出的PITX1已在稍前不久的另一项研究中得到证实.结论:用新的分析方法研究已公开的表达谱芯片资料为研究肿瘤的发病机制提供了新的手段.