Goldblum John R, Lauwers Gregory Y
Cleveland Clinic Foundation, OH 44195, USA.
Semin Diagn Pathol. 2002 Feb;19(1):12-9.
Barrett's esophagus is a complication of chronic gastroesophageal reflux disease and is defined as a change in the esophageal epithelium of any length that can be recognized at endoscopy and is confirmed to have intestinal metaplasia by biopsy. Esophageal ulcerations and stricture are rarely seen, and the major complications of this disease are epithelial dysplasia and esophageal adenocarcinoma. Dysplasia is felt to represent the best currently available marker of increased cancer risk in these patients. However, there are many pitfalls in the histologic recognition of dysplasia, a particularly difficult problem in the face of active inflammation in patients with ongoing reflux disease. The recognition and grading of dysplasia is subject to significant interobserver variability, particularly at the lower end of the histologic spectrum (negative v indefinite for dysplasia v low-grade dysplasia). High-grade dysplasia and to a lesser degree low-grade dysplasia are markers of increased cancer risk, although their natural history are difficult to determine. Up to 40% of patients with a preoperative diagnosis of high-grade dysplasia have an adenocarcinoma in their esophagectomy specimen. Despite this observation, there is still debate as to whether esophagectomy or close endoscopic surveillance with biopsy is the most appropriate and cost-effective way to manage these patients. The search for more objective surrogate biomarkers that recognize patients who are truly at risk of progressing along the dysplasia-carcinoma sequence is underway. However, no biomarker has yet proven to be superior to the histologic recognition of dysplasia in identifying these high-risk patients.
巴雷特食管是慢性胃食管反流病的一种并发症，定义为在内镜检查中可识别的任何长度的食管上皮变化，并经活检证实有肠化生。食管溃疡和狭窄很少见，该疾病的主要并发症是上皮发育异常和食管腺癌。发育异常被认为是目前这些患者癌症风险增加的最佳可用标志物。然而，发育异常的组织学识别存在许多陷阱，对于患有持续性反流病且伴有活动性炎症的患者来说，这是一个特别棘手的问题。发育异常的识别和分级存在显著的观察者间差异，尤其是在组织学谱的低端（发育异常阴性与不确定与低级别发育异常）。高级别发育异常以及程度较轻的低级别发育异常是癌症风险增加的标志物，尽管它们的自然病程难以确定。术前诊断为高级别发育异常的患者中，高达40%在食管切除标本中发现有腺癌。尽管有此观察结果，但对于食管切除术或密切的内镜活检监测是否是管理这些患者最合适且最具成本效益的方法仍存在争议。目前正在寻找更客观的替代生物标志物，以识别真正有沿着发育异常 - 癌序列进展风险的患者。然而，在识别这些高危患者方面，尚未有生物标志物被证明优于发育异常的组织学识别。
