Goldstein N S
Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Mod Pathol. 2000 Oct;13(10):1072-9. doi: 10.1038/modpathol.3880198.
Gastric cardia intestinal metaplasia (CIM), denoted by goblet cells is common. The frequency of persistent CIM is unknown.
85 patients with CIM and follow-up endoscopies were prospectively identified during the time period of 10/6/94-12/21/97. The presence of goblet cells was the defining feature of CIM, other metaplastic cell types were not evaluated. AU 85 patients initially had biopsies that straddled the squamocolumnar junction (SCJ) showed CIM, an otherwise normal proximal stomach, lower esophagus, and squamocolumnar junction. The SCJ lay within the 2 cm of mucosa immediately proximal to the uppermost gastric fold and overlaid the junction of the tubular esophagus and the saccular dilatation of the stomach in all patients. The patients underwent endoscopy for many reasons. They were randomly identified based on the absence of a hiatal hernia and the presence of CIM.
Ten of the 85 patients had CIM on repeat biopsy. Among patients with no CIM in the first repeat endoscopy, the degree of cardia inflammation decreased between the initial and first repeat endoscopy, whereas there was no change in the amount of inflammation among patients who had CIM in the first repeat endoscopy. The changes in mean inflammation score was significantly different between the two groups (P = .024). Twenty-two patients underwent a second repeat endoscopy and five had a third repeat endoscopy. Including all follow-up biopsies, six of the 85 patients (7%) had CIM. Four patients who did not have CIM on initial repeat endoscopy had CIM on their second repeat endoscopy, probably reflecting sampling issues. None of the biopsies had dysplasia.
Cardia inflammation is a stimulus for cardia intestinal metaplasia, and a reduction in inflammation may allow the metaplastic mucosa to revert to normal.
以杯状细胞为特征的贲门肠化生（CIM）很常见。持续性CIM的发生率尚不清楚。
在1994年10月6日至1997年12月21日期间，前瞻性地确定了85例患有CIM并接受随访内镜检查的患者。杯状细胞的存在是CIM的决定性特征，未评估其他化生细胞类型。所有85例患者最初在跨越鳞柱状交界处（SCJ）的活检中显示有CIM，近端胃、食管下段和鳞柱状交界处其他部位正常。在所有患者中，SCJ位于紧邻最上方胃皱襞的2 cm黏膜内，覆盖管状食管与胃囊状扩张的交界处。这些患者因多种原因接受内镜检查。他们是根据无食管裂孔疝和存在CIM随机确定的。
85例患者中有10例在重复活检时仍有CIM。在首次重复内镜检查时无CIM的患者中，贲门炎症程度在初次检查和首次重复检查之间有所减轻，而在首次重复内镜检查时有CIM的患者中炎症程度没有变化。两组之间平均炎症评分的变化有显著差异（P = 0.024）。22例患者接受了第二次重复内镜检查，5例接受了第三次重复内镜检查。包括所有随访活检，85例患者中有6例（7%）有CIM。4例在初次重复内镜检查时无CIM的患者在第二次重复内镜检查时有CIM，这可能反映了取样问题。所有活检均无发育异常。
贲门炎症是贲门肠化生的一个刺激因素，炎症减轻可能使化生黏膜恢复正常。
