Barrett食管症状、内镜下分型与病理特征探讨

目的 研究Barrett食管（BE）患者的症状、内镜下分型与病理特征的关系。方法 采用胃食管反流病（GERD）问卷（GerdQ）调查7 150例因上消化道症状而行胃镜检查的患者，GerdQ总分≥8分诊断为GERD。将胃镜检查诊断为BE的患者，根据胃镜下形态分为长节段BE （LSBE）组（n=27）和短节段BE （SSBE）组（n=65）；并以贲门肠化（CIM）组（n=78）作为对照，记录各组内镜下齿状线位置及有无食管炎症。取各组食管活检标本，采用HE、AB及Giemsa 染色观察组织病理学特征、不典型增生和幽门螺杆菌（H.pylori）感染等情况。结果内镜检查者中BE患者共92例，检出率1.29%。LSBE、SSBE和CIM组中GERD和食管炎发病率分别为92.59%、69.23%、41.03%和100.00%、78.46%、29.49%，不典型增生发生率分别为66.67%、24.62%和10.26%，组间比较差异均有统计学意义（P<0.05或P<0.01）。LSBE组肠上皮化生（IM）的发生率为74.07%，高于SSBE组的50.77%（P<0.05）。LSBE组和SSBE组Hp感染率分别为18.52%、21.54%，均显著低于CIM组的47.44%（P<0.05）。与CIM组比较，BE患者更易见隐窝萎缩紊乱、鳞状上皮叠压于柱状上皮、肠化、食管导管及多层上皮（均P<0.05）；鳞状上皮叠压于柱状上皮和食管导管仅见于BE患者。结论 BE患者容易产生GERD和食管炎症状以及发生IM和不典型增生，其中LSBE患者更明显；BE患者的Hp感染率较低。隐窝萎缩紊乱、鳞状上皮叠压于柱状上皮、肠化、食管导管及多层上皮与BE诊断有关，其中鳞状上皮叠压于柱状上皮和食管导管为BE患者特有。

Relationship among symptoms, endoscopic classification and pathological characteristics of Barrett esophagus

Objective To investigate the relationship among symptoms, endoscopic classification and pathological characteristics of Barrett esophagus (BE). Methods A total of 7 150 patients undergoing gastroscopic examinations for upper gastrointestinal tract symptoms were investigated with gastroesophageal reflux disease (GERD) questionnaire (GerdQ), and GERD was diagnosed when GerdQ sum score was ≥8. Among those diagnosed as BE by gastroscopic examinations, long-segment BE (LSBE) group (n=27) and short-segment BE (SSBE) group (n=65) were divided according to the morphology under gastroscope, and 78 patients with cardia intestinal metaplasia (CIM) were served as controls (CIM group). The esophagitis was observed under endoscope in each group. The biopsy specimens were obtained, and the histopathological features, dysplasia and helicobacter pylori (H.pylori) infection were observed with HE, AB and Giemsa staining respectively. Results Endoscopic examinations revealed that the prevalence of BE was 1.29%. The prevalences of GERD in LSBE group, SSBE group and CIM group were 92.59%, 69.23% and 41.03% respectively, the prevalences of esophagitis were 100.00%, 78.46% and 29.49% respectively, and the prevalences of dysplasia were 66.67%, 24.62% and 10.26% respectively, with significant differences among groups (P＜0.05 or P＜0.01). The prevalence of intestinal metaplasia in LSBE group was 74.07%, which was significantly higher than that in SSBE group (50.77%)(P＜0.05). The Hp infection rates in LSBE group and SSBE group were 18.52% and 21.54% respectively, which were significantly lower than that in CIM group (47.44%)(P＜0.05). Crypt disarray and atrophy, squamous epithelium overlying columnar crypts, intestinal metaplasia, esophageal ducts and multilayered epithelium were more likely to be found in patients with BE group than in CIM group (P＜0.05), and squamous epithelium overlying columnar crypts and esophageal ducts were exclusively found in patients with BE. Conclusion GERD, esophagitis, specialized intestinal metaplasia and dysplasia are more likely to occur in patients with BE, especially in those with LSBE. The Hp infection rate in patients with BE is low. Crypt disarray and atrophy, squamous epithelium overlying columnar crypts, intestinal metaplasia, esophageal ducts and multilayered epithelium are associated with the diagnosis of BE. Squamous epithelium overlying columnar crypts and esophageal ducts are exclusively in patients with BE.