Jaspersen D, Diehl K L, Geyer P, Martens E, Arps H
Medizinische Klinik II, Städtisches Klinikum Fulda.
Dtsch Med Wochenschr. 1999 Feb 26;124(8):205-8. doi: 10.1055/s-2007-1024274.
Benign stenoses can occur anywhere in the oesophagus, but are most common in its distal part as a result of gastro-oesophageal reflux (GOR). It was the aim of this study to evaluate retrospectively the causes and incidence of benign stenosis of the proximal oesophagus (SPR) as well as its endoscopic and drug treatment.
Between December 1989 and December 1997 a total of 17,413 patients were referred to the authors' hospital for oesophago-gastroduodenoscopy, 1024 of them (6%) for clarification of heartburn, regurgitation and/or dysphagia. 53 of these patients (5%) were found to have benign stenosis of the oesophagus requiring bougie dilatation, located in the lower third in 29 (55%), in the middle third in six (11%) and in the upper third in 18 (34%) patients. Causes of stenosis in the upper third were peptic stricture in nine (50%), heterotopic gastric mucosa in three (17%), caustic corrosion in three (17%), post-radiation in two (11%), and the result of web formation in one (6%). Endoscopic bougie dilatation was performed in all these patients, those with GOR additionally receiving 40 mg omeprazole daily.
In those patients with nonpeptic benign stenosis/stricture lasting improvement of symptoms was achieved with one to three dilatation. But those with GOR needed a mean of 13 dilatations during a follow-up period averaging 61 months. Barrett's oesophagus (replacement of squamous by columnar epithelium) was found in five patients. No case of dysplasia was discovered. Laparoscopic fundoplication was performed in one woman in whom bougie dilatation had failed. Remission was maintained, as needed, by bougie and omeprazole in eight patients.
In benign stenosis of the upper oesophagus endoscopic dilatation is the treatment of choice. In cases of peptic aetiology the administration of proton pump inhibitors is the optimal adjuvant method.
良性狭窄可发生于食管的任何部位，但由于胃食管反流（GOR），最常见于食管远端。本研究旨在回顾性评估食管近端良性狭窄（SPR）的病因、发生率及其内镜和药物治疗。
1989年12月至1997年12月期间，共有17413例患者因食管胃十二指肠镜检查转诊至作者所在医院，其中1024例（6%）是为了明确烧心、反流和/或吞咽困难。这些患者中有53例（5%）被发现患有需要探条扩张的食管良性狭窄，其中29例（55%）位于食管下三分之一，6例（11%）位于中三分之一，18例（34%）位于上三分之一。上三分之一狭窄的病因包括消化性狭窄9例（50%）、异位胃黏膜3例（17%）、腐蚀性损伤3例（17%）、放疗后2例（11%）以及蹼形成1例（6%）。所有这些患者均接受了内镜探条扩张，患有GOR的患者额外每天服用40mg奥美拉唑。
在那些非消化性良性狭窄/缩窄的患者中，通过一至三次扩张症状得到持续改善。但患有GOR的患者在平均61个月的随访期内平均需要13次扩张。5例患者发现有巴雷特食管（柱状上皮取代鳞状上皮）。未发现发育异常病例。1例女性患者探条扩张失败后接受了腹腔镜胃底折叠术。8例患者根据需要通过探条和奥美拉唑维持缓解。
食管上段良性狭窄时，内镜扩张是首选治疗方法。对于消化性病因的病例，质子泵抑制剂的应用是最佳辅助方法。
