反流性食管炎的X线检查与胃镜检查对比分析

目的 对比分析反流性食管炎的X线特征及胃镜检查结果.方法 185例反流性食管炎患者,行数字胃肠食管气钡双重造影及胃镜检查,观察其X线特征,并与胃镜结果对照分析.结果 185例反流性食管炎的X线表现特征:轻度63例,表现为食管排空缓慢,钡剂滞留,功能性改变,出现异常收缩波;中度112例,表现为食管管壁粗糙,糜烂所致针尖状钡点和走行紊乱之肥厚的黏膜皱襞,可见多发小星状龛影或网织交错样龛影,食管壁轻度变形;重度10例,由于瘢痕形成食管腔变狭窄,狭窄上段食管多扩张、管壁僵硬、粗糙、边缘不规则,狭窄段常有短缩.内窥镜检查:轻度反流性食炎黏膜表面发红、充血,有少许渗出.中度返流性食炎黏膜糜烂,融合成片,有溃疡形成.重度反流性食管炎有明显溃疡伴有狭窄.结论 数字胃肠检查可对反流性食管炎进行全面的观察,但内窥镜则较为理想.     

反流性食管炎误诊为食管癌1例

1　病历简介患者 ,男 ,73岁。吞咽困难 3年 ,时轻时重 ,严重时进水困难。伴有烧心 ,胸骨后疼痛 ,自觉卧位症状加重。经抗炎、溃疡类药物治疗症状缓解。X线、内窥镜表现 :食管钡餐检查显示食管下 1/3段狭窄 ,狭窄段管壁僵硬 ,但尚能扩张 ,局部管壁内凹 ,有数个小龛影 (图 1,2 )。上段食管扩张。贲门口宽大 ,有明显的胃 -食管反流。心肺未见异常。纤维胃镜检查显示入镜45cm见数条纵行溃疡 ,周围水肿 ,上覆白苔 ,取出病变区组织 5块送检。X线、内窥镜诊断 :食管癌。病理诊断 :食管炎 ,食管溃疡。图 1　食管充盈像显示下 1 / 3段食管狭窄 ,管腔…     

食管裂孔疝伴反流性食管炎患者X线钡餐与内镜检查动力学对比研究

为探讨X线钡餐与内镜检查在反流性食管炎合并食管裂孔疝（HH）患者中的诊断价值以及两者在临床应用的优选问题,将50例确诊为反流性食管炎伴食管裂孔疝患者分为HH1组（A、B级）和HH2（C、D级）。在1周内行X线钡餐与内镜检查,并将结果进行对照分析。X线钡餐和胃镜检查中,两者疝囊诊断率为100%和60%,HH1组的反流方式以抽吸型为主,占78.57%(22/28),而HH2组以倾倒型为主,占81.82%(18/22)。HH1组的廓清方式以被动廓清为主,占64.29%(18/28),而HH2组以延迟廓清为主,占90.91%(20/22),且随着食管炎的加重而加重,延迟廓清呈逐渐增多趋势,内镜检查均可见食管粘膜炎症表现,食管下段粘膜以糜烂、溃疡为主,X线钡餐与内镜检查诊断符合率为60%,两种检查方法均适用于食管裂孔疝诊断,X线钡餐以简便、痛苦少而常首选,但对于合并反流性食管炎或其他并发症时应以内镜检查为宜。     

胃镜下微波治疗Barrett食管术的应用和护理

Barrett食管是指食管下段的复层鳞状上皮被特殊的柱状上皮替代的一种病理现象。此病最严重的有10％的病人可以癌变，通常认为是癌前病变，所以有症状要早期进行检查治疗。Barrett食管多是由长期反流性食管炎造成的，是胃食管反流病的并发症之一。在胃食管反流病患者中，至少有10％发生Barrett食管，发病率约为18／10万，发病年龄为40～60岁。     

食管反流与反流性食管病的数字摄影诊断

目的探讨食管反流及反流性食管病的数字摄影诊断. 资料与方法对428例可疑反流性食管病患者行直立、仰卧、俯卧位数字摄影术.分析胃食管反流的表现. 结果胃食管反流82例,占19.2%,包括单纯性反流,反流合并食管裂孔疝、食管炎、食管溃疡、癌、静脉曲张等. 结论胃食管反流的检出率取决于正确的影像形态学认识和检查方法,数字摄影能动态反映食管胃连接处的形态变化,特别是能对下食管括约肌(LES)的功能作出评判.     

胃食管反流的X线检查

胃食管反流样症状的人相当常见，对有症状的患者，现在许多医师都以纤维食管胃镜作为胃食管反流（GER）首选的检查方法。但内窥镜检查毕竟会给病人带来一定的痛苦，我院坚持作食管钡餐X线检查，优化检查技术，提高诊断准确性，以维持X线检查在食管中原来的作用。     

食管癌切除机械吻合术后重建食管的测压和pH分析

为探讨食管癌切除食管胃机械吻合术后重建食管与胃食管反流之间的关系 ,对 45例术后患者进行了食管胃的压力测定 ,其中 2 0例还进行了 2 4h食管pH监测、内镜检查及病理学检查。测压显示食管胃吻合口上方的压力高于吻合口下方 ,2 4h食管 pH监测结果有胃食管反流的存在 ,内镜和病理检查示 80 %患者有异常现象及食管炎征象。结果提示 ,食管癌切除食管胃吻合术后存在胃食管反流 ;反流的发生与术后时间的长短无关 ;半卧位睡眠是预防反流的有效方法 ;2 4hpH监测是敏感的观察方法     

i-Scan染色对非糜烂性胃食管反流病诊断研究

目的探讨i-Scan染色对非糜烂性胃食管反流病的诊断价值。方法回顾性分析解放军477医院自2013年6月至2016年8月收治的42例行电子胃镜检查结合i-Scan染色确诊为非糜烂性胃食管反流病患者的临床资料。采用i-Scan染色结合放大内镜检查,观察食管下段近贲门处黏膜,于异常黏膜所见处靶向取活检,与病检结果进行比较。结果 42例患者经i-Scan染色,依据镜下特异性表现符合为非糜烂性胃食管反流病,结合病理检查确诊非糜烂性胃食管反流病的诊断。结论通过i-Scan染色可初步诊断非糜烂性胃食管反流病,并且可以发现许多白光下不易发现的反流性食管炎、Barrett食管。     

食管壁内假性憩室影像学表现

目的提高对食管壁内假性憩室的诊断水平。方法报道3例食管壁内假性憩室钡餐造影资料,介绍了本组3例所行食管气钡和(或)低张气钡对比检查方法,效果良好。结果3例均显示典型食管壁内假性憩室的小囊袋状改变,囊袋大小1~4 mm,颈部长为1~2 mm。2例为弥漫型分布全食管,1例为节段型分布于中下段;2例可见部分憩室颈部斜向胃端走行,夹角在30°~45;°1例可见憩室间通道形成,通道长5~10 mm;3例中仅1例(例3)食管末端狭窄,显示反流性食管炎改变;1例(例1)行食管纤维内镜检查,能清楚发现憩室口部,组织学见憩室颈部周围少量炎性浸润,颈部和底部衬以移行的黏膜上皮和结缔组织。结论本病少见,其检查价值在于与各种食管炎并发的早期表浅溃疡、食管穿孔等病鉴别。食管钡造影检查示食管壁内斜行走向的颈管为其表现特征。     

胃食管钡剂反流敏感试验

作者用X线,内窥镜和24小时食管内pH测定检查了50例胃食管反流患者,男性29例,女性21例,平均48岁。钡餐检查时迅速吞下250%(W/V)E-Z-EM钡60ml,行食管双对比造影,摄左后斜位和立位点片。测量弛张的贲门段食管内径宽度,     

Short-segment Barrett's esophagus: findings on double-contrast esophagography in 20 patients

OBJECTIVE: The purpose of this study was to determine the findings of short-segment Barrett's esophagus on double-contrast esophagography. MATERIALS AND METHODS: A review of pathology and endoscopy data revealed 142 patients with short-segment Barrett's esophagus, which was defined as columnar epithelium in the distal esophagus extending 3 cm or less above the gastroesophageal junction at endoscopy with histopathologic confirmation of intestinal metaplasia. Twenty of these patients underwent double-contrast esophagography. These 20 patients comprised our study group. The original radiology reports and images were reviewed to determine the findings on double-contrast esophagography. Medical records were also reviewed to determine the clinical findings and treatment. RESULTS: Double-contrast esophagrams revealed hiatal hernias in 18 patients (90%), gastroesophageal reflux in 16 (80%), reflux esophagitis in seven (35%), peptic scarring or strictures in 11 (55%), and a reticular mucosal pattern in none. A total of 14 patients (70%) had morphologic findings of reflux disease with esophagitis alone (three patients), peptic scarring or strictures alone (seven patients), or both (four patients), but the remaining six (30%) had hiatal hernias or gastroesophageal reflux as the only radiographic finding. CONCLUSION: Double-contrast esophagography revealed morphologic findings of reflux disease with esophagitis, peptic scarring or strictures, or both in 70% of patients with short-segment Barrett's esophagus. Thus, the absence of esophagitis or peptic scarring or strictures on double-contrast esophagography does not exclude the possibility of short-segment Barrett's esophagus.     

Barrett's esophagus: diagnosis by double-contrast esophagography

A blinded, retrospective study was performed to determine the role of double-contrast esophagography in diagnosing Barrett's esophagus. The study group consisted of 200 patients who had double-contrast esophagrams and endoscopy because of severe reflux symptoms. The radiographs were reviewed by two gastrointestinal radiologists who had no knowledge of the endoscopic findings. Patients were classified as being at high risk for Barrett's esophagus if the radiographs revealed a high stricture or ulcer or a reticular mucosal pattern; at moderate risk if the radiographs revealed a distal peptic stricture and/or reflux esophagitis; and at low risk if none of the aforementioned findings were present. When these radiologic criteria were used, 10 patients (5%) were thought to be at high risk, 73 (37%) at moderate risk, and 117 (58%) at low risk for Barrett's esophagus. Endoscopic correlation revealed biopsy-proved Barrett's mucosa in nine (90%) of 10 patients at high risk, in 12 (16%) of 73 at moderate risk, and in only one (1%) of 117 at low risk for Barrett's esophagus. Thus, endoscopy is clearly indicated for patients in the high-risk group. Because of the lower prevalence of Barrett's esophagus in the moderate-risk group, clinical judgment should be used in deciding when to perform endoscopy in these patients. However, most patients were in the low-risk group, and the prevalence of Barrett's esophagus was so low in this group that endoscopy does not appear to be warranted. Thus, the major value of double-contrast esophagography is its ability to separate patients into high-, moderate-, and low-risk groups for Barrett's esophagus to determine the relative need for endoscopy and biopsy.     

Early esophageal cancer

Early esophageal cancer (EEC) accounted for only seven (4.7%) of 148 cases of esophageal cancer diagnosed at the authors' hospital between 1977 and 1984. Two patients with EEC had squamous cell carcinoma and five had adenocarcinoma arising in Barrett's mucosa. All seven patients had associated clinical findings, including low-grade gastrointestinal bleeding (three cases), odynophagia (one case), and chronic reflux symptoms due to underlying reflux esophagitis and Barrett esophagus (three cases). Since Barrett esophagus is a premalignant condition, the high proportion of adenocarcinomas in this series presumably reflects the more frequent radiologic evaluation of symptomatic patients with Barrett esophagus. On esophagography, four patients had 3-4.5-cm polypoid intraluminal masses that could not be distinguished radiographically from advanced esophageal carcinoma. In the other three patients, esophagrams revealed secondary achalasia, irregular flattening of the esophageal wall, and diffuse nodularity of the mucosa. The authors conclude that "early" esophageal cancers are not necessarily small cancers, since they may undergo considerable intraluminal or intramural growth and still be classified histologically as EEC. Radiologists should be aware of these findings, since EEC has an excellent prognosis with a 5-year survival approaching 90%.     

Feasibility of instructing radiology technologists in the performance of gastrointestinal fluoroscopy

OBJECTIVE: We sought to determine if dedicated gastrointestinal technologists could be trained to properly perform esophagography and double-contrast barium enema examinations. SUBJECTS AND METHODS: Ninety-four patients undergoing double-contrast barium enema examinations and 123 patients undergoing esophagographic examinations were included in the study. The study was conducted over a 4-month period, with examinations performed by eight gastrointestinal technologists, 10 radiology residents, and four staff radiologists. Four random lists were generated for each set of examinations. Each staff gastrointestinal radiologist, who was unaware of who had performed the examination, independently scored the representative radiographs. RESULTS: For the double-contrast barium enema examinations, no statistically significant differences were found between the technologists and residents for amount of barium used, degree of distention, cecal opacification, and quality of spot radiographs. The technologist-performed examinations had a statistically significant lower mean fluoroscopy time (3.2 min, compared with 4.0 min for staff radiologists and 5.7 min for residents). For the esophagrams, no statistically significant differences between technologists and residents were found for single-contrast esophagrams; radiographs of the gastric cardia; assessment of motility, reflux, and transit of a solid bolus; and fluoroscopy time. Double-contrast esophagrams obtained by technologists received a better mean score than did those of the residents. CONCLUSION: Radiology technologists can be trained to perform high-quality esophagography and double-contrast barium enema examinations without an unacceptably high radiation dose.     

Barrett esophagus as an extension of severe esophagitis: analysis of radiologic signs in 29 cases

Twenty-nine cases of Barrett esophagus verified by endoscopy and 16 cases confirmed by histology were reviewed for pertinent radiologic signs. All patients had barium-filled and mucosal relief films, and all but five cases had double-contrast films. Common radiologic signs in descending order were thickened and irregular mucosal folds (28/29), hiatal hernia (26/29), esophageal stricture (25/29), esophageal ulcer (20/29), distal esophageal widening (19/29), granular mucosal pattern (16/24), reticular mucosal pattern (9/24), and intramural pseudodiverticula (6/29), all of which are also recognized signs of reflux esophagitis. Midesophageal stricture, esophageal ulcer, and distal esophageal widening were particularly indicative of Barrett esophagus. Since there appears to be no specific sign of Barrett esophagus, a multifaceted approach is suggested concentrating on the association of Barrett esophagus with the radiographic signs of severe reflux esophagitis.     

The reticular pattern as a radiographic sign of the Barrett esophagus: an assessment

A two-part retrospective study was conducted to assess the value of a reticular pattern as a sign of columnar-lined esophagus. Radiographic, endoscopic, and histologic findings were reviewed in 124 patients with known Barrett esophagus; then all barium esophagrams done at our institution during a 3 1/2 month period were reviewed and presence of a reticular pattern was correlated with available endoscopic and histologic data. In patients with known Barrett esophagus, the reticular pattern was found in 26% of double-contrast examinations. Twelve of these patients underwent careful esophageal mapping biopsies: the pattern was in squamous mucosa with ulceration in two, in columnar epithelium with ulceration in six, and in columnar epithelium without ulceration in four. In the group of 314 unselected patients who had double-contrast examinations, the reticular pattern was found in 26 (8%). Thirteen of the 26 had had endoscopy and biopsy: the site of the pattern was located in a squamous carcinoma in one, in squamous epithelium adjacent to squamous carcinoma in three, in squamous epithelium with esophagitis in five (two of whom had columnar mucosa distally), in normal squamous mucosa in one, and in columnar epithelium with esophagitis in three. The reticular pattern is a strong indicator of important esophageal disease, but is not specific for Barrett esophagus.     

Radiographic findings in children and young adults with Barrett's esophagus

The upper-gastrointestinal examinations of 32 patients (mean age, 11 years) with histologically proven Barrett's esophagus were reviewed to evaluate the radiologic findings in children. All patients had symptoms of chronic gastroesophageal reflux and/or esophagitis, including atypical findings such as aspiration pneumonia, seizures, and failure to thrive. Fourteen patients had other diseases that might predispose them to abnormal esophageal motility and gastroesophageal reflux. Twenty-five patients had single-contrast and seven patients had double-contrast examinations. Four patients had normal single-contrast studies; 24 had gastroesophageal reflux; 12 had strictures; 10 had esophageal ulcers; and only four had hiatal hernias. The most notable difference between the results of endoscopy and the upper-gastrointestinal studies was the rate of detection of esophageal ulcers. Ten of the patients with single-contrast studies had ulcers seen at endoscopy but not shown radiologically. No specific radiologic signs of Barrett's esophagus were found, although most of our patients had abnormal upper gastrointestinal studies.     

A comparative assessment of tube esophagography with double-contrast esophagography in the detection of reflux esophagitis

We undertook a prospective study comparing the sensitivities of double-contrast and tube esophagography in 34 patients with gastroesophageal reflux and compared our findings with those at endoscopy. Neither test detected changes accurately in mild inflammation; however, they both became more sensitive as the severity of esophagitis increased. The sensitivity of both tests increased from 0% in grade 2 to 86% in grade 4 esophagitis. The tube esophagogram demonstrated inflammatory changes better than the double-contrast esophagogram in only 18% of the 34 patients, all with grade 3 or 4 esophagitis, despite the elimination of the barium pool in the distal esophagus and improved distension of the esophagogastric junction. Endoscopy is still the most reliable means of diagnosing and grading esophagitis.     

Work in progress: transverse striations of the esophagus: association with gastroesophageal reflux

Transverse mucosal ridging of the esophagus may be demonstrated on double-contrast esophagrams as transverse striations. A case review of 44 patients who had transverse striations was performed to evaluate the significance of the striations with respect to gastroesophageal reflux. Gastroesophageal reflux was significantly more common among patients who had transverse striations than it was in the general population who had been referred for the barium meal. This does not imply that all patients with transverse striations or with reflux at fluoroscopy have esophagitis. However, recognition of transverse striations should prompt careful evaluation for reflux and associated complications in symptomatic patients.     

Flow artifacts in double-contrast esophagography

Artifacts related to barium flow during double-contrast esophagography may obscure mucosal surface details. Double-contrast esophagograms with flow artifacts of 35 patients were evaluated to determine the effect on radiographic interpretation and to assess the method of examination. Initial radiographs obtained during swallowing of barium were compared with those obtained after a slight delay while patients repeatedly dry swallowed. When severe surface flow artifacts were present, the extent of mucosal disease was underestimated in all cases. Mild surface flow artifacts interfered with the demonstration of the reticular pattern of Barrett esophagus, and luminal flow artifacts caused misinterpretation. The demonstration of strictures was unaffected by flow artifacts. This study suggests that the dry swallowing maneuver and some delay improve depiction of esophageal surface details on double-contrast radiographs and obviate interpretive error from barium flow artifacts.