Stolte M, Vieth M, Schmitz J M, Alexandridis T, Seifert E
Institute for Pathology, Klinikum Bayreuth, Germany.
Scand J Gastroenterol. 2000 Nov;35(11):1125-30. doi: 10.1080/003655200750056574.
The application of hyperplasia of the basal cell layer and elongation of the papillae in the squamous epithelium of the distal oesophagus, as histological criteria for the diagnosis of gastro-oesophageal reflux disease (GORD), continues to be controversial. An unanswered question is whether these changes may regress under long-term treatment with proton pump inhibitors (PPI). This fact prompted us to investigate the effect of PPI treatment on the histological changes observed in the lower oesophagus.
295 patients with endoscopically confirmed erosive GORD were investigated by endoscopy/biopsy prior to and during the course of a 12-month PPI treatment regimen (8 weeks acute treatment with 30 mg lansoprazole/day followed by long-term treatment with 15 or 30 mg lansoprazole or 20 mg omeprazole/day). The parameters studied were the frequency of ulcers and erosions and the hyperplasia of the basal cell layer and elongation of the papillae prior to treatment and on day 56 (D56), after 6 months (M6) and after 12 months (M12) of treatment.
In the various treatment groups, the results showed no statistically significant differences. Ulcers and erosions (prior to treatment 21% and 31%, respectively) were detected statistically significantly less frequently under PPI treatment (ulcers, D56: 1%, M6 and M12, 0%; erosions, D56: 2%, M6: 4%, M12, 3%). While high-grade hyperplasia of the basal cell layer and elongation of the papillae was found in 51% of the cases prior to treatment, the corresponding figures were only 3% (D56, M6) and 2% (M12). In contrast, the percentage of cases with normal oesophageal epithelium increased from 8% before treatment to 55% (D56), 66% (M6) and 63% (M12).
Our study shows not only that erosions and ulcers heal under PPI treatment, but also that hyperplasia of the basal cell layer and elongation of papillae in the squamous epithelium of the oesophageal mucosa may normalize, and are thus presumably not 'normal physiological variants'.
将远端食管鳞状上皮基底细胞层增生和乳头延长作为胃食管反流病（GORD）诊断的组织学标准，其应用一直存在争议。一个尚未解决的问题是，这些改变在质子泵抑制剂（PPI）长期治疗下是否会消退。这一事实促使我们研究PPI治疗对食管下段观察到的组织学变化的影响。
295例经内镜确诊的糜烂性GORD患者在12个月PPI治疗方案（先用30mg兰索拉唑/天进行8周急性治疗，随后用15mg或30mg兰索拉唑或20mg奥美拉唑/天进行长期治疗）之前及治疗期间接受了内镜检查/活检。研究的参数包括治疗前、治疗第56天（D56）、治疗6个月（M6）和治疗12个月（M12）时溃疡和糜烂的发生率以及基底细胞层增生和乳头延长情况。
在各个治疗组中，结果显示无统计学显著差异。PPI治疗下溃疡和糜烂（治疗前分别为21%和31%）的检出频率在统计学上显著降低（溃疡，D56：1%，M
