Guo Jin-Ping, Gilman Philip B, Thomas Rebecca M, Fisher Robert S, Parkman Henry P
Division of Gastroenterology, Samaritan Program, Temple University Health System, Temple University Hospital, Philadelphia, Pennsylvania, USA.
J Clin Gastroenterol. 2002 Apr;34(4):439-43. doi: 10.1097/00004836-200204000-00011.
Two unusual cases of achalasia with endoscopic and histologic documentation of Barrett's esophagus are presented. One patient had Barrett's esophagus at the time of initial endoscopy for achalasia, before any treatment. The other patient developed specialized columnar epithelia in the esophagus after treatment with pneumatic dilation. Each patient had evidence of low-grade dysplasia. Including these two patients, 30 cases of Barrett's esophagus in patients with achalasia have been reported in the literature. In 73% (22 of 30) of the cases, Barrett's esophagus was detected after esophagomyotomy. In 20% (6 of 30) of the cases of achalasia and Barrett's esophagus, adenocarcinoma developed. The current two cases are unusual because Barrett's esophagus in achalasia generally develops from gastroesophageal reflux after esophagomyotomy. No other patients have been reported to develop Barrett's esophagus after pneumatic dilation alone. Patients with achalasia and Barrett's esophagus may be at a particularly high risk for developing dysplasia and adenocarcinoma.
本文介绍了两例罕见的贲门失弛缓症病例，伴有巴雷特食管的内镜和组织学记录。一名患者在初次因贲门失弛缓症进行内镜检查时，在未接受任何治疗之前就已患有巴雷特食管。另一名患者在接受气囊扩张治疗后，食管出现了特殊的柱状上皮。两名患者均有低度发育异常的证据。包括这两名患者在内，文献中已报道了30例贲门失弛缓症患者并发巴雷特食管的病例。在73%（30例中的22例）的病例中，巴雷特食管是在食管肌层切开术后被发现的。在20%（30例中的6例）的贲门失弛缓症合并巴雷特食管病例中，发生了腺癌。目前这两例病例较为罕见，因为贲门失弛缓症中的巴雷特食管通常是在食管肌层切开术后由胃食管反流发展而来。尚未有其他患者仅在接受气囊扩张后就发生巴雷特食管的报道。贲门失弛缓症合并巴雷特食管的患者可能发生发育异常和腺癌的风险特别高。
