54例Barrett食管临床研究

目的 分析Barrett食管（barrecc esophagus，BE）患者的临床特点，尤其是胃镜下表现度食管动力改变，以提高BE的诊断率，以期早期治疗。方法 回顾分析54例BE患者的临床资料。结果 22例行食管动力检查提示LESP厦屏障压（LESP-GS）明显降低，酸反流总时间、酸反流总次数以度食管下段pH〈4时间百分比均明显增加。系统治疗后，41例患者在该院行胃镜复诊，21例（51．22％）仍为BE，19例（46．34％）患者恢复正常食管上皮，1例（2．44％）进展为食管腺癌。结论 BE是胃食管反流痛（gastroesophageal reflux disease，GERD）严重的并发症；内镜下治疗联合抑酸治疗为BE治疗提供新的方法。     

Barrett食管的临床及病理研究

目的:探讨Barrett食管的临床及病理特点。方法:回顾性分析32例经胃镜及病理确诊的Barrett食管的临床表现、内镜及病理特点。结果:32例Barrett食管患者中临床出现反酸25例(78.1%)、胸骨后疼痛22例(68.8%)、烧心感18例(56.3%),无症状者6例(18.8%),胃镜检查伴有反流性食管炎表现者27例(84.4%),胆汁反流者10例(31.3%),病理检查结果全部病例食管下段均有柱状上皮化生。结论:Barrett食管多见于老年人,是反流性食管炎发展的结果,具有恶变为食管癌的潜在危险,其确诊须组织病理检查,内科治疗只能缓解及改善症状,发现恶变及早手术。     

非糜烂性反流病研究概况

胃食管反流病（GERD）是由于下段食管括约肌功能障碍引起胃内容物反流导致的一系列慢性症状和食管黏膜损害。其疾病谱广泛，包括反流性食管炎（RE）、非糜烂性反流病（NERD）及Barrett食管（BE），是临床上的常见病、多发病，该病症状多，既有消化道症状，又有消化道外症状。NERD是指具有典型的反流症状但内镜检查食管黏膜正常者，亦称内镜阴性反流病或称症状性GERD。     

质子泵抑制剂对糜烂性食管炎抑酸效应的影响

胃食管反流病（GERD）是指胃内容物反流引起不适症状和（或）并发症的一种疾病。其中包括非糜烂性反流病占60％～70％，糜烂性食管炎占20％～30％，Barrett食管占6％～10％。质子泵抑制剂已成为目前胃食管反流病公认和首选的抑酸药物。     

胃食管反流病的研究进展

胃食管反流病(GERD)是指胃内容物反流入食管,引起不适症状和(或)并发症的一种疾病。根据内镜和病理结果可将GERD分为三类:(1)反流性食管炎(RE):有反流症状兼有食管黏膜破损者;(2)非糜烂性食管反流病(NERD):有反流症状但内镜下未见食管破损者;(3)Barrett食管(BE):食管黏膜上皮被胃柱状上皮所替代。GERD为常见的慢性疾病,易反复发作,严重影响患者的生活质量,造成沉重的经济和社会负担。本文就该病的发病机制、诊断及治疗进展做一简要综述。     

胃食管反流病的食管外表现

胃食管反流病（gastroesophageal reflux disease，GERD）是一颇为常见的消化系统疾病，因与食管腺癌等疾病的发生相关而日益受到人们的关注。GERD是指胃、十二指肠内容物反流入食管引起的反酸等症状，可导致反流性食管炎及Barrett食管等合并症。GERD是由于多种因素的作用导致的消化道动力障碍性疾病，除可具有食管本身损伤及食管症状外，还可引起呼吸道、咽喉、耳鼻及口腔等食管以外的组织器官损伤和症状。由于胃、十二指肠反流而产生的胃肠道以外的相应症状，称之谓GERD食管外表现。有研究…表明，在6215例GERD患者中，具有食管外表现者占32．8％，其中，反流性食管炎患者占具有食管外表现的GERD患者的34．9％，非糜烂性食管炎（NERD）患者占30．5％。患者的性别、年龄、反流性食管炎的分级、GERD症状持续的时间及吸烟等因素，均与食管外表现的发生有关。GERD伴有食管外表现的患者，可以具有典型的胃食管反流症状，也可以没有反流症状，因而给诊断增加了难度。而且，即使24h食管内pH监测结果阳性，亦很难确定食管外表现与GERD之间的因果关系。     

非糜烂性反流病诊断研究中的几个热点问题

胃食管反流病（gastroesophageal reflux disease,GERD）是指胃内容物反流入食管引起不适症状和（或）并发症的一种疾病[1].2006年蒙特利尔共识意见对GERD进行了重新定义和分类.GERD分为食管综合征和食管外综合征.前者包括症状综合征（典型反流症状和反流相关胸痛）和食管损伤综合征[反流性食管炎,食管狭窄,Barrett＇s食管（Barrett＇s esophagous,BE）及食管腺癌];后者包括一些已肯定与反流相关的综合征如反流性咳嗽、反流性喉炎、反流性哮喘及反流性牙侵蚀,同时还包括了一些与反流可能相关的综合征如咽炎、鼻窦炎、特发性肺纤维化及复发性中耳炎.根据内镜所见,一般还可将GERD分为非糜烂性反流病（non-erosive reflux diseases,NERD）、糜烂性食管炎（erosive esophagitis,EE）及BE三种类型[2].     

胆汁反流与Barrett食管

Barrett食管(Barrett’s esophagus，BE)是食管复层鳞状上皮细胞被单层柱状上皮细胞取代的一种病理现象，组织学表现为含有杯状细胞和柱状细胞的肠上皮化生，在形态学和超微结构上具有鳞状上皮和柱状上皮的特点。BE被认为是胃食管反流病(gastroesophageal reflux disease，GERD)最严重的并发症，对伴有GERD症状的患者进行胃镜检查时，约有12％的患者被发现BE。目前认为BE是食管腺癌的先兆，属癌前状态，约有10％的BE患者可能发展为食管腺癌。     

胃-食管黏膜哨兵皱襞病例报告并文献复习(附12例)

目的 明确内镜下胃-食管黏膜哨兵皱襞临床意义，提高对该征象的认识。方法 对1999年1月～2003年7月南山医院内镜检出的胃-食管哨兵皱襞12例患者资料进行回顾性分析，所有病例均行皱襞黏膜病理组织学检查。结果 12例哨兵皱襞患者中，位于胃-食管黏膜连接处大弯侧8例，占67％；前壁2例，占17％；后壁1例，占8％；小弯侧1例，占8％。伴有反流性食管炎3例，占25％。皱襞活检组织学表现：病变可见柱状上皮、淋巴细胞、中性粒细胞浸润，部分有鳞状上皮，上皮有轻度增生。结论 分布在胃-食管连接处的隆起性息肉样病变，往往是哨兵皱襞，而非息肉，应先行皱襞病理组织学检查，有食管反流者，可行抗反流药物治疗，而不应被误为食管息肉切除。     

45例Barrett食管临床病理分析

Barrett食管（BE）指食管下段正常鳞状上皮被柱状上皮取代的一种改变。是由于长期慢性胃食管反流病而引起的严重并发症，由于与食管腺癌的关系密切而引起高度关注。作者回顾本院20134年1月至2007年2月经内镜及病理组织学诊断的BE患者45例，就其内镜特征、临床表现及病理特点进行分析，报道如下。     

Barrett's esophagus occurring as a complication of scleroderma

Two patients had both scleroderma and a columnar epithelium-lined lower esophagus (Barrett esophagus). Features of Barrett's esophagus included high esophageal strictures in both patients and ulcer craters in the columnar area of one. Biopsy confirmed columnar epithelium in the lower esophagus of each patient. In these patients, the Barrett esophagus probably was a complication of scleroderma and resulted from long-standing gastroesophageal reflux.     

Controversies in Barrett Esophagus

Barrett esophagus develops when metaplastic columnar epithelium predisposed to develop adenocarcinoma replaces esophageal squamous epithelium damaged by gastroesophageal reflux disease. Although several types of columnar metaplasia have been described in Barrett esophagus, intestinal metaplasia with goblet cells currently is required for a definitive diagnosis in the United States. Studies indicate that the risk of adenocarcinoma for patients with nondysplastic Barrett esophagus is only 0.12% to 0.38% per year, which is substantially lower than previous studies had suggested. Nevertheless, the incidence of esophageal adenocarcinoma continues to rise at an alarming rate. Regular endoscopic surveillance for dysplasia is the currently recommended cancer prevention strategy for Barrett esophagus, but a high-quality study has found no benefit of surveillance in preventing deaths from esophageal cancer. Medical societies currently recommend endoscopic screening for Barrett esophagus in patients with multiple risk factors for esophageal adenocarcinoma, including chronic gastroesophageal reflux disease, age of 50 years or older, male sex, white race, hiatal hernia, and intra-abdominal body fat distribution. However, because the goal of screening is to identify patients with Barrett esophagus who will benefit from endoscopic surveillance and because such surveillance may not be beneficial, the rationale for screening might be made on the basis of faulty assumptions. Endoscopic ablation of dysplastic Barrett metaplasia has been reported to prevent its progression to cancer, but the efficacy of endoscopic eradication of nondysplastic Barrett metaplasia as a cancer preventive procedure is highly questionable. This review discusses some of these controversies that affect the physicians and surgeons who treat patients with Barrett esophagus. Studies relevant to controversial issues in Barrett esophagus were identified using PubMed and relevant search terms, including Barrett esophagus, ablation, dysplasia, radiofrequency ablation, and endoscopic mucosal resection.     

Videoendoscopy and histopathology of the esophagogastric junction in patients with gastroesophageal reflux disease

BACKGROUND AND AIMS: During endoscopy the stomach is considered to rise at the level of the 'gastric' folds; however, anatomical studies have demonstrated that the proximal gastric folds may in fact be esophageal. This prospective study was designed to assess the histopathology of endoscopically visible proximal gastric folds in patients with gastroesophageal reflux disease. METHODS: 35 consecutive patients (20 males) with gastroesophageal reflux disease underwent video endoscopy, including biopsy sampling from the endoscopically visible esophagogastric junction (0 cm, 0.5 cm and 1.0 cm distal to the rise of gastric folds and 0.5 cm and 1.0 cm proximal to it). Endoscopy was digitally recorded and reviewed for assignment of biopsy level. Columnar-lined esophagus and esophagitis were cataloged according to the Paull-Chandrasoma histopathologic classification and the Los Angeles endoscopic classification. RESULTS: Endoscopy: Normal endoscopic esophagogastric junction was seen in 11 (31%) patients and visible columnar-lined esophagus < or = 0.5 cm in 24 (69%). Histology: Columnar-lined esophagus extended 1.0 cm in 22.8% of patients and 0.5 cm in 51.4%, distal to the rise of the gastric folds. In all patients columnar-lined esophagus was interposed between squamous epithelium and gastric oxyntic mucosa. Thus, so-called gastric folds contained mucosa of esophageal origin in all patients. Intestinal metaplasia (Barrett esophagus) was detected in eight (22.9%) patients. CONCLUSIONS: Endoscopy cannot exclude histopathologic columnar-lined esophagus within gastric rugae. Thus, visible 'gastric' folds should not be used for definition of the esophagogastric junction but as a reference landmark for biopsy sampling during endoscopy.     

反流性食管炎与非糜烂性胃食管反流的反流类型及其意义

目的探讨酸反流和胆汁反流在非糜烂性胃食管反流中的意义.方法具有典型的胸痛、反酸、反食等反流症状患者,同步进行24 h食管下段酸及胆汁反流监测,结合胃镜结果分为两组,反流性食管炎（RE）组21例,非糜烂性胃食管反流（NERD）组34例.结果 RE组混合反流发生率47.6%,酸反流发生率38.1%,胆汁反流发生率14.3%;NERD组混合反流发生率20.6%,酸反流发生率为50.0%,胆汁反流发生率29.4%.RE组混合反流发生率显著高于NERD组（P＜0.05）.结论 RE与NERD的反流类型存在一定的差异.NERD以酸反流为主,但也存在胆汁反流,单纯的胆汁反流不易引起食管炎发生,而混合反流则易致食管黏膜的损伤.     

Expression of transcription factor in Barrett's esophagus

Barrett's esophagus is the result of chronic injury which is usually caused by gastroesophageal reflux. NF-kappaB is expressed in the reflux esophagitis. Specialized columnar epithelium (SCE) is characteristic of Barrett's esophagus and has a malignant predisposition. SCE expresses Cdx1 and Cdx2. Adenocarcinoma in Barrett's esophagus is believed to develop through the metaplasia-dysplasia-carcinoma sequence. P53, beta-catenin, PPARgamma, and estrogen receptor beta are closely related to the development of esophageal carcinogenesis.     

Barrett Esophagus

Barrett esophagus is a metaplastic change in the lining of the distal esophageal epithelium, characterized by replacement of the normal squamous epithelium by specialized intestinal metaplasia. The presence of Barrett esophagus increases the risk of esophageal adenocarcinoma several-fold. Esophageal adenocarcinoma is a malignancy with rapidly rising incidence and persistently poor outcomes when diagnosed after the onset of symptoms. Risk factors for Barrett esophagus include chronic gastroesophageal reflux, central obesity, white race, male gender, older age, smoking, and a family history of Barrett esophagus or esophageal adenocarcinoma. Screening for Barrett esophagus in those with several risk factors followed by endoscopic surveillance to detect dysplasia or adenocarcinoma is currently recommended by society guidelines. Minimally invasive nonendoscopic tools for the early detection of Barrett esophagus are currently being developed. Multimodality endoscopic therapy—using a combination of endoscopic resection and ablation techniques—for the treatment of dysplasia and early adenocarcinoma is successful in eliminating intestinal metaplasia and preventing progression to adenocarcinoma, with outcomes comparable to those after esophagectomy. Risk stratification of those diagnosed with Barrett esophagus is a challenge at present, with active research focused on identifying clinical and biomarker panels to identify those with low and high risk of progression. This narrative review highlights some of the challenges and recent progress in this field.     

Barrett食管的病理本质及其与返流性食管炎,食管腺癌关系的研究

从１０００例食管粘膜咬检及１５８０例食管贲门癌切除标本中交界处癌１６５例的形态学、粘液组化及ＦＣＭ分析，探讨ＢＥ病理本质及其与返流性食管炎、食管腺癌的关系。结果：１０００例咬检中２２７例有不同程度的返流性食管炎，其中３例符合ＢＥ。１５８０例食管贲门癌中，交界处癌２３例（１．５％）为食管腺癌，１３例（５６．５％）根据部位、形态、粘液组化分析证明为ＢＥ来源的腺癌。本文认为慢性胃液返流使食管粘膜鳞状上皮长期受损，修复中，部分病例食管鳞状上皮由邻接耐酸性较强、增殖更活跃的胃贲门上皮向上异位生长而代替。长期非特异性刺激附加致癌因素刺激下，修复性增生转变为渐进性异型增生，最终导致癌变，形成ＢＥ来源的腺癌。     

胃食管反流病合并食管裂孔疝患者的临床特点分析

目的分析胃食管反流病(GERD)合并食管裂孔疝(HH)患者的临床特点及其危险因素。方法回顾性分析2018年1月-2019年3月在宁夏回族自治区人民医院消化内科诊断为GERD合并HH的40例患者并作为研究组,另外40例GERD未合并HH的患者为对照组,比较两组患者的基本临床资料、内镜分级、Barrett食管发生率。结果研究组患者的年龄、体重、吸烟史、糖尿病与对照组比较,差异均有统计学意义(P<0.05),两组性别、饮酒史和冠心病比较,差异均无统计学意义(P>0.05);研究组食管外症状较多见,内镜下分级仅有C级与对照组比较差异有统计学意义(P<0.05);A级、B级、D级两组差异无统计学意义(P>0.05);两组Barrett食管发生率比较,差异有统计学意义(P<0.05)。结论GERD合并HH与年龄、体重、吸烟史、糖尿病有关,且其会使Barrett食管发生率升高,积极防控可改变的因素对该类患者可能有一定的好处。     

Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux

In a 6.5 year period starting January 1982, 121 patients (74 male, 47 female; 1.6:1) with complicated gastroesophageal reflux referred to Alberta Children's Hospital, University of Calgary, required a Nissen fundoplication at a mean age of 35.5 months (range 3 weeks to 18 years). The median age of onset of symptoms was less than 1 month. Symptoms and indications for surgery included regurgitation (88%), failure to thrive (52%), reflux-associated pulmonary symptoms and aspiration (48%), biopsy evidence of esophagitis (35%) with heartburn (17%), dysphagia (18%), hematemesis (17%), anemia (13%), and hypoproteinemia (22%). Sixty-four percent of the patients had a syndrome or chromosomal abnormality, respiratory disease, or neuromuscular disorder. The barium contrast upper-gastrointestinal radiographic series, performed in all patients, identified structural [gastric outlet obstruction (2%), esophageal stricture (11%), erosive esophagitis (9%)], and functional abnormalities [gastroesophageal reflux (90%), barium aspiration (8%), esophageal hypoperistalsis (30%), delayed gastric emptying (4%)]. Barium contrast upper gastrointestinal radiographic series identified gastroesophageal reflux with a sensitivity of 90% (compared to history), was 50% sensitive and 92% specific for erosive esophagitis (compared to biopsy), was 59% sensitive and 74% specific for esophageal dysmotility (compared to esophageal manometry), and there was a significant (p less than 0.01) association between barium aspiration and prior evidence of aspiration pneumonitis. Esophageal manometry demonstrated a significantly (p less than 0.001) lower esophageal sphincter pressure in patients compared with controls, but no significant correlation with failure to thrive, aspiration pneumonia, biopsy evidence of esophagitis, or parameters of the 24-hour esophageal pH study. Twenty-four hour pH monitoring showed significantly (p less than 0.05) more reflux episodes than in asymptomatic controls and there was significant (p less than 0.05) correlation between the percentage of time pH was less than 4 and the presence of hypoalbuminemia, and biopsy-proven erosive esophagitis or Barrett's esophagus. Endoscopic appearance was 91% sensitive and 60% specific for esophagitis when compared to biopsy. Nissen fundoplication was completely effective at resolving gastroesophageal reflux in 83%, and associated with marked improvement in 15%. No patient died as a result of fundoplication. Major complications included: recurrence of symptoms requiring reoperation (2%), subsequent mechanical bowel obstruction (8%), wound infection or pneumonia (12%).