慢性食管炎内窥镜检查与X线表现分析

目的:总结探讨食管炎胃镜检查及X线诊断的经验。材料与方法:对80例经胃镜检查及病理证实的慢性食管炎的X线表现与胃镜所见进行对比分析。结果:80例慢性食管炎X线表现为:(1)黏膜皱襞改变,黏膜增粗,紊乱不规则;(2)充盈缺损气泡征;(3)食管边缘小锯齿征,管壁无僵硬感;(4)病变区与正常食管界线不清呈移行性,与胃镜下观察所见四级改变相一致。结论:X线检查对慢性食管炎诊断具有重要作用,而胃镜对慢性食管炎定位、定性诊断具有较高价值。     

艾滋病合并念珠菌食管炎的放射诊断及鉴别诊断

目的:探讨艾滋病合并念珠菌食管炎的X线表现特点。材料与方法:回顾性分析经证实的42例艾滋病合并念珠菌食管炎的X线特点。结果:组患者中所有病例食管动力异常,以中下段食管(31/42)受累为主且随病变进展范围呈由下向上发展,34例呈毛刷样边缘,29例黏膜表面呈鹅卵石样充盈缺损。结论:本病是AIDS患者最常见的食管机会性感染,"毛刷征"与"鹅卵石征"是其主要X线特点,可一定程度在影像学与其他食管机会性感染进行鉴别。     

数字胃肠X线造影与内镜检查对真菌性食管炎诊断的对照研究

目的通过与内镜分级表现相对照,探讨数字胃肠造影技术对真菌性食管炎的诊断价值,并对真菌性食管炎X线分度标准的临床应用进行评价。方法选取45例经内镜和涂片病原学检查确诊的病例,对数字胃肠造影和内镜检查中真菌性食管炎的分度/分级表现进行分析。结果在确定真菌性食管炎的分度/分级表现时,数字胃肠造影检查与内镜检查相比,Kappa值为0.543,具有中高度的一致性。对其中13例病灶很小(直径≤1mm或病灶呈粟粒样)的真菌性食管炎病例,其在黏膜相中的显示情况(9/13)优于在双对比相(4/13)和钡剂充盈相(0/13)中的显示情况。结论对于粟粒样的病灶,数字胃肠造影检查的动态黏膜图像往往更易发现病变。真菌性食管炎X线分度标准具有较好的临床应用价值,但在其可操作性上还可以进一步改进。     

滑动型食管裂孔疝伴反流性食管炎X线造影及临床分析

目的探讨X线造影对滑动型食管裂孔疝伴反流性食管炎的诊断准确性。方法通过X线常规造影筛查并行特殊方法造影确诊120例滑动型食管裂孔疝伴返流性食管炎。结果 120例均有不同程度的症状与食管形态学的改变。其中胸痛、上腹胀痛10例(8.3%),反酸嗳气、胸骨后烧灼感75例(62.5%);120例均见膈上疝囊并可见粗大的黏膜及食管裂孔增宽>4 cm,出现A环或B环75例(62.5%),食物反流及频繁的第3收缩波出现60例(50.0%),夜间睡眠时食物反流35例(29.2%),His角增大变钝70例(58.3%)。结论常规X线造影+特殊方法造影对滑动型食管裂孔疝伴反流性食管炎的诊断有重要意义,且操作简单,易于开展,可作为诊断的首选。     

重度反流性食管炎的X线造影表现特点

目的探讨重度反流性食管炎的X线造影表现特点,以提高对该病的影像诊断水平。方法回顾性分析伴有溃疡或狭窄的重度反流性食管炎32例,所有病例均经内镜活检或细胞学证实,其中11例经手术及病理证实。结果32例中发生于食管下段27例(84.4%),中下段4例(12.5%),上段1例(3.1%);病变长度1~4cm,平均3.7cm。黏膜不规则28例(87.5%);黏膜呈小结节状或息肉状改变14例(43.8%);合并食管溃疡16例(50%)。锥形狭窄13例(40.7%),弧形狭窄12例(37.5%),不规则结节状狭窄7例(21.9%)。病变与正常食管壁分界清楚及不清楚者各16例(50%)。假性憩室者8例(25%),固定的横行黏膜纹4例(11.8%),病变上端食管局限性囊袋样膨出9例(28.1%)。局部管壁柔软19例(59.4%),僵硬13例(40.6%)。病变下缘累及贲门者5例,合并食管裂孔疝22例(71.9%)病例中病变下缘均累及膈上疝囊。结论重度反流性食管炎的X线造影多表现为食管下段狭窄、溃疡,合并食管裂孔疝,如发现假性憩室、固定的横行黏膜纹及病变上端食管局限性囊袋样膨出等征象则有助于诊断。     

膀胱破裂的X线造影诊断

目的：探讨膀胱破裂的X线膀胱造影诊断价值：方法：回顾分析7例膀胱破裂的临床及X线膀胱造影特征。结果：膀胱腹膜外破裂1例,膀胱呈梨状,造影剂外渗至膀胱前间隙;膀胱腹膜内破裂6例,造影剂外溢并聚积于膀胱后上缘、小肠周围及结肠旁沟5例;未见造影剂外溢1例．经膀胱镜检及手术证实为膀胱腹膜内破裂,裂口被疝入膀胱的小肠阻塞。结论：X线膀胱造影是膀胱破裂的有效和可靠诊断方法。     

小肠平滑肌肉瘤的影像学诊断

目的 探讨小肠平滑肌肉瘤的X线钡剂造影表现、B超及CT的特征。方法 分析了经手术病理证实的31例小肠平滑肌肉瘤的影像学表现。其中26例行钡餐造影检查，11例行钡灌肠检查，25例行B超检查，17例行CT扫描。结果 8例腔内型钡餐造影见肠腔内肿物。黏膜展平呈弧形，管腔增宽，管壁不整，3例有小溃疡龛影。7例腔外型X线钡剂造影可见肠道受压移位改变，局部肠壁不整，13例腔内外型钡餐造影表现为腔内充缺，黏膜紊乱，管腔狭窄，6例有溃疡穿孔。B超22例发现腹部不规则软组织肿块，内部回声不均，10例肿物内有肠气反射。CT扫描发现腹内肿物12例，4例肿物内见有造影剂渗入。结论 X线钡剂造影仍是小肠平滑肌肉瘤简便的首选检查方法，B超、CT亦为重要的补充检查，特别是对于腔外型和腔内外型病变，恰当地结合应用可以提高小肠肿瘤的诊断准确率。     

数字X线胃肠机对早期食管癌的诊断

目的探讨数字X线胃肠机诊断早期食管癌的诊断价值。方法回顾性分析60例应用数字X线机行食管双对比造影检查并经胃镜、手术病理证实的早期食管癌的X线表现。结果60例早期食管癌病例中，食管上段癌11例，中段癌19例，下段癌30例；病变深度：原位癌16例，黏膜内癌19例，黏膜下癌25例。结论数字X线胃肠机对早期食管癌的诊断、治疗及预后有极其重要的意义。     

胃窗造影剂在消化性溃疡超声诊断中的应用

由于胃、十二指肠等空腔脏器内大量气体及内容物的干扰,超声对消化性溃疡的检查有很大的局限性,所以临床常以胃镜或X线钡餐造影作为首选诊断方法。应用胃窗超声造影剂可以有效排除胃、十二指肠腔气体干扰,增加胃、十二指肠壁对比度,并可清晰显示胃壁厚度、胃壁层次、黏膜面及胃邻近脏器情况。本研究采用胃窗造影剂超声检查与胃镜及X线钡餐造影检查对比,取得了良好的效果,报告如下。     

X线和CT诊断十二指肠腺癌的效果比较

目的:分析探究十二指肠腺癌诊断中X线和CT诊断的价值。方法:采集研究对象为2017年10月至2019年10月病理检查为十二指肠腺癌患者45例,所有患者均先后采用X线和CT进行诊断,对比两种诊断方式的诊断准确率与应用价值。结果:CT诊断准确率(91.1%)高于X线诊断准确率(64.4%),差异显著有统计学意义,P<0.05;诊断显示有22例十二指肠病变位置在降部,6例于水平部,17例于壶腹部;X线诊断为发病早期组织较软,呈现为结节状,表现为息肉形式,直到中晚期会呈现溃疡与浸润状态,且十二指肠病变部位变硬,阻碍钡剂流通,破坏黏膜组织;CT诊断为发病早期十二指肠病变部位呈现圆形软组织肿块样,发展至中晚期十二指肠病变部位变硬,且指肠变狭窄,肿块逐渐蔓延。结论:由于X线在十二指肠腺癌诊断中存在一定的局限性,因而可将CT诊断应用在十二指肠腺癌诊断中,可明显提高诊断准确率,便于准确发现病变部位,以及病变状况。     

Endoscopic surveys in high-risk and low-risk populations for esophageal cancer in China with special reference to precursors of esophageal cancer

Endoscopic surveys were carried out of the people in high-risk and low-risk areas of esophageal cancer in Henan Province, China. Chronic esophagitis was observed with endoscopy in 70.67% of the inhabitants in the high-risk area and in 63.67% of the individuals in the low-risk area. The prevalence rate of chronic esophagitis diagnosed with histological examination was 78.28% and 71.33% in the two groups, respectively. Basal-cell hyperplasia and dysplasia were present in 74% and 38.28% of the populations, respectively, in the high-risk area, and in 48% and 4.78% of the inhabitants in the low-risk area. A correlation between the incidence of dysplasia and the severity of esophagitis was found in two groups. One-hundred-and-eighty-six cases of chronic esophagitis in high-risk areas were followed-up with endoscopy from 30 to 78 months. Of the 186 cases, in 62 accompanied by dysplasia 21 (33.87%) developed early stage esophageal carcinoma; and in 124 cases with esophagitis alone or simple hyperplasia cancer was found in 5 (4.03%). We suggest that chronic esophagitis is the commonest disease of the esophagus due to mechanical irritation, thermal injury and vitamin deficiencies, while the inflammatory injury may increase the sensitivity of the esophageal mucosa to carcinogens. It might be concluded that esophagitis with dysplasia was likely to develop into esophageal carcinoma and that treatment of this disease would be important to decrease the incidence rate of esophageal cancer.     

内镜检查中反流性食管炎及相关因素的调查分析

目的探讨内镜检查中反流性食管炎及其相关因素如食管裂孔疝的发病情况及临床特点。方法回顾我院1999年1月-2000年12月胃镜检查资料，检出符合标准的反流性食管炎、食管裂孔疝及其它与食管炎相关的病例，分析各种病例检出情况、临床特点及合并症。结果反流性食管炎167例，检出率3．85％；食管裂孔疝101例，检出率2、47％；其中反流性食管炎合并食管裂孔疝66例(39．52％)，而食管裂孔疝中61．68％合并反流性食管炎；反流性食管炎合并十二指肠溃疡并不全梗阻37例(22．16％)，胆汁反流7例(4．19％)，急性胃黏膜病变4例(2．39％)，残胃6例(3．59％)。另外，反流性食管炎中有20例(11．97％)患者表现为贲门松弛。食管炎合并食管裂孔疝的患者较单纯食管裂孔疝的患者年龄明显增大，前者58、88岁，后者40．03岁。合并食管炎的食管裂孔疝患者反酸、烧心症状的发生率较单纯裂孔疝高。结论反流性食管炎与很多因素有关，食管裂孔疝为反流性食管炎的重要病因，随着年龄增大食管裂孔疝合并反流性食管炎的机率增加、尤其是老年人伴有反流症状的更要引起注意。     

A case of pill-induced esophagitis with mucosal dissection

With the advance of gastrointestinal endoscopy, pill-induced esophagitis has been detected more frequently, but the association of mucosal dissection is rare. We reported a case of pill-induced esophagitis associated with mucosal dissection.A 66-year-old male with combined valvular heart disease was admitted for cardiac surgery. Cefotiam hydrochloride tablet was administered for postoperative wound infection of cardiac surgery. Next morning severe odynophagia and retrosternal pain were occurred. Upper gastrointestinal endoscopy performed 2 days after onset of the symptom showed detached mucosa at the upper thoracic esophagus and acute esophagitis at middle and lower thoracic esophagus. Histological examination of the mucosa revealed that the esophageal mucosa was detached from the lamina propria. After the treatment for esophagitis, almost normal esophageal mucosa covered the esophagus without scarring or stricture.The present case was diagnosed as cefotiam hydrochloride tablet induced esophagitis because of the onset of this disease. Mucosal dissection of the esophagus may be associated with both the esophagitis and bleeding tendencies caused by anticoagulant therapy.     

L’œsophagite à éosinophiles

Eosinophilic esophagitis (EE) is a recent diagnosis of growing prevalence which must be considered in children and adult patients, more often in male. EE is a chronic, immune/antigen-mediated, and esophageal-limited disease characterized by eosinophil-predominant inflammation. EE should always be considered in any impaction or dysphagia, but the spectrum of clinical manifestations is broad including manifestations of gastro-esophageal reflux disease resistant to anti-secretory. The endoscopic appearance alone can be misleading and only histological examination can confirm the diagnosis by showing infiltration of the esophagus with eosinophils. In other cases, drug therapy is based on inhibiting the proton pump and topical steroids aimed at controlling inflammation to prevent progression to fibrosis and esophageal strictures.     

24小时食管pH监测和内镜检查在胃食管反流病的诊断价值

目的:本文旨在探讨食管pH监测和内镜检查在GERD中的诊断价值。方法:临床诊断GERD患者121例行内镜及pH检查,对照组18例行内镜和pH检查。结果:内镜食管炎检出率51.2％(74/121),pH检测,阳性率87.6％(106/121)。对74例内镜诊断的食管炎与pH检测进一步分析显示食管酸暴露时间越长,内镜下炎症程度及症状越重。而32例内镜阴性的症状性反流性食管炎,症状多为轻中度,pH<4的总时间％的值亦偏低,但其数值与食管酸暴露数值有重叠。故不能以内镜阳性作为诊断GERD的客观依据,必须结合使用其他方法才能回答有否反流。结论:24h pH确实是诊断GERD的比较理想的方法。     

Lymphocytic esophagitis: Report of three cases and review of the literature

Lymphocytic esophagitis (LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema (“spongiosis”). The clinical significance and natural history of LyE is poorly defined although dysphagia is reportedly the most common symptom. Endoscopic features range from normal appearing esophageal mucosa to features similar to those seen in eosinophilic esophagitis, including esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis. Symptomatic gastroesophageal reflux disease is an inconsistent association. LyE has been associated in paediatric Crohn’s disease, and recently in primary esophageal dysmotility disorder in adults. There are no studies assessing effective treatment strategies for LyE; empirical therapies have included use of proton pump inhibitor and corticosteroids. Esophageal dilatation have been used to manage esophageal strictures. LyE has been reported to run a benign course; however there has been a case of esophageal perforation associated with LyE. Here, we describe the clinical, endoscopic and histopathological features of three patients with lymphocytic esophagitis along with a review of the current literature.     

Long-term results of conservative management of reflux esophagitis

Reflux esophagitis is a frequent and chronic disease. Impairment of the quality of life by the reflux symptoms and the risk of complications are the most important indications for a long-term treatment. The base of the treatment of reflux esophagitis is the inhibition of the gastric acid secretion with proton pump inhibitors (PPI) or by H2-receptor antagonist. In general, PPI's are more efficient in the treatment of refluxesophagitis as compared to H2-receptor antagonists blockers regarding the relieve of symptoms and the healing of erosive esophageal lesions. The use of an antacids and procinetics in the long-term treatment is not indicated. The treatment strategy depends on the severity of the symptoms and the esophageal lesions. Patient with mild esophagitis can be treated either with H2-receptor antagonists or with PPI's on demand or continuous. In the case of severe esophagitis, a long-term treatment with PPI's is indicated to avoid complications. Recurrence of esophagitis during a long-term therapy should be treated by PPI's. After healing the long-term treatment should be adapted either by increasing the given dose of the medicament or by a switch to more effective medicaments in acid suppression.     

Brush cytology in the diagnosis of herpetic esophagitis. A case report

We present a case of herpetic esophagitis in a patient with acute renal failure. Herpes virus infection was detected in one of 386 gastroesophageal brush cytologies performed. Al-though the endoscopic appearance suggested candidiasis, and a biopsy specimen was interpreted as peptic esophagitis, brush cytology identified viral particles that were confirmed by serologic tests and cultures. A common cause of esophageal ulceration in immunosuppressed patients, herpetic esophagitis is occasionally reported in otherwise healthy immunocompetent persons. For its timely diagnosis and appropriate treatment, this article advocates systematic brush cytology during gastro-esophageal endoscopy.     

Pathogenesis of gastro-esophageal reflux disease

Gastro-esophageal reflux disease (GERD) refers a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The disease was subclassified into esophageal and extraesophageal syndromes in the new Montreal Definition. Hiatal hernia, decreased lower esophageal sphincter, transient lower esophageal sphincter relaxation, esophageal acid clearance, and delayed gastric emptying might be implicated as the pathogenesis of esophageal syndrome. Although non-erosive reflux disease (NERD) is included in the esophageal syndrome, it might be different from reflux esophagitis because of the lower response rates to acid suppression with proton pump inhibitors. Esophageal visceral hypersensitivity, sustained esophageal contractions, and abnormal tissue resistance are thought to be the mechanisms of NERD. Further investigations for the pathogenesis of each classification are expected.     

Significance of diffuse granularity and nodularity of the esophageal mucosa at double-contrast radiography

Out of 5000 consecutive double-contrast examinations of the esophagus, 50 cases presented a diffuse finely granular or nodular appearance of the mucosa. Endoscopy was subsequently performed in 38 cases and biopsy in the majority of these.In 23 of the 38 verified cases the diagnosis was reflux esophagitis. In the other 15 cases the diagnoses were: candidal esophagitis (4), leukoplakia (2), glycogenic acanthosis (1), and diffuse leiomyomatosis (1). A normal mucosa was demonstrated in 7 cases. Our study indicates that a radiologically granular or nodular appearance of the esophageal mucosa often indicates reflux esophagitis and less commonly identifies diffuse lesions of variable origin.