Haag S, Holtmann G
Dept. of Gastroenterology and Hepatology, Institute of Internal Medicine, University of Essen, Essen, Germany.
Endoscopy. 2003 Feb;35(2):112-7. doi: 10.1055/s-2003-37013.
Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders. The key feature of GERD is reflux of gastric contents into the esophagus. Medical treatment with proton-pump inhibitors (PPIs) is well established and is considered the standard treatment. Given the high prevalence of the condition and the excellent response to medical therapy, antireflux surgery is an option for patients with volume reflux that is not properly controlled by medical therapy. Adenocarcinoma is a rare but life-threatening complication of GERD. The only known precursor lesion for esophageal adenocarcinoma is Barrett's esophagus. In recent years, a clearer understanding of the development of Barrett's and of its progression toward invasive cancer has developed. Genetic factors almost certainly determine the individual risk. The length of the Barrett's esophagus segment and the size of a hiatal hernia are associated with the risk of developing high-grade dysplasia and esophageal adenocarcinoma.With regard to the clinical management of GERD patients with Barrett's, endoscopic surveillance at 3-year intervals is now considered appropriate in the absence of dysplasia. In patients with high-grade dyspepsia, the situation is more difficult. While a considerable proportion of these patients may already have invasive cancers, there is also the possibility that there is only focal dysplasia. For this reason, it is justifiable to carry out curative endoscopic resection. Mucosal ablation procedures may also be appropriate, but these still need to be properly investigated in clinical trials.
胃食管反流病（GERD）是最常见的胃肠道疾病之一。GERD的关键特征是胃内容物反流至食管。质子泵抑制剂（PPI）药物治疗已得到充分确立，并被视为标准治疗方法。鉴于该疾病的高发病率以及对药物治疗的良好反应，抗反流手术是药物治疗无法有效控制大量反流患者的一种选择。腺癌是GERD一种罕见但危及生命的并发症。已知的食管腺癌唯一前驱病变是巴雷特食管。近年来，对巴雷特食管的发展及其向浸润性癌进展的认识更加清晰。几乎可以肯定，遗传因素决定个体风险。巴雷特食管段的长度和食管裂孔疝的大小与发生高级别异型增生和食管腺癌的风险相关。对于患有巴雷特食管的GERD患者的临床管理，在无异型增生的情况下，目前认为每3年进行一次内镜监测是合适的。对于患有高级别异型增生的患者，情况更为棘手。虽然这些患者中有相当一部分可能已经患有浸润性癌症，但也有可能仅存在局灶性异型增生。因此，进行根治性内镜切除是合理的。黏膜消融手术也可能是合适的，但仍需要在临床试验中进行适当研究。
