消化性食管狭窄:来自阿根廷的一份报告。
Peptic esophageal stricture: a report from Argentina.
作者信息
Mazzadi Sergio Angel, García Alfredo Omar, Salis Graciela Beatriz, Chiocca Juan Carlos
机构信息
Gastroenterology Service, Hospital Profesor Alejandro Posadas, Palomar City, Argentina.
出版信息
Dis Esophagus. 2004;17(1):63-6. doi: 10.1111/j.1442-2050.2004.00375.x.
Peptic esophageal stricture (PES) is a major complication of gastroesophageal reflux disease. The aims of this paper were to determine the characteristics of these patients with regard to demography, morphology, functional status and results of therapy. The charts of the patients treated at our service who underwent esophageal dilatation for PES between 1971 and 1998 were reviewed. Statistical analyses were performed by means of chi2, Mann-Whitney and Student's t-tests. One hundred and thirty-five patients with PES were dilated by various means. The mean age was 61.1 +/- 16.3 years, the ratio of men to women was 2.75/1 and mean duration of symptoms was 44.4 +/- 74.6 months. Their symptoms were dysphagia in 100%, pyrosis in 70%, and regurgitation in 40% of the cases. There was an average weight loss of 3.3 +/- 6 kg. The upper gastro-intestinal series showed pre- and post-dilatation diameters at the stricture of 8 +/- 2.5 mm and 15.9 +/- 1.2 mm, respectively. The stricture was located at the lower third of the esophagus in 97% and at the middle third in 3% of the cases. We found PES endoscopically in all instances, with different degrees of erosions in 64%, ulcers in 20% and Barrett's esophagus in 16% of the cases. The biopsy samples showed intestinal metaplasia in 16% and esophagitis in 75.5%, being normal in the remaining 8.5%. Brush cytology was negative for malignancy in 100% of the cases. Esophageal manometry showed peristaltic wave amplitude of 40 +/- 3 mmHg and presence of peristaltic waves of 62 +/- 38.6%. LES pressure was 8.6 +/- 6.3 mmHg (NV 24.2 +/- 6.3 mmHg). Measurement of pH showed 15% of patients had pH < 4. Patients needed a mean of 4.7 +/- 1.6 dilations per case, with successful results in 87.2% of cases. The perforation rate was 0.1% of the total number of procedures and 0.7%, of patients. The mortality rate was 0.7% (one case). We observed PES relapse in 32% of the cases. There was no correlation between relapse, age, duration of the stenosis or pharmacological treatment with H2 blockers or proton pump inhibitors. We conclude that in Argentina, demography, morphology, functional status and results of dilatation of PES patients are similar to those reported in the Western world, with the exception of the different behavior seen after treatment with H2 blockers or proton pump inhibitors.
消化性食管狭窄(PES)是胃食管反流病的一种主要并发症。本文旨在确定这些患者在人口统计学、形态学、功能状态及治疗结果方面的特征。回顾了1971年至1998年间在我院接受食管扩张治疗的PES患者的病历。采用卡方检验、曼-惠特尼检验和学生t检验进行统计学分析。135例PES患者接受了各种方式的扩张治疗。平均年龄为61.1±16.3岁,男女比例为2.75∶1,平均症状持续时间为44.4±74.6个月。100%的患者有吞咽困难症状,70%有烧心症状,40%有反流症状。平均体重减轻3.3±6kg。上消化道造影显示狭窄处扩张前后直径分别为8±2.5mm和15.9±1.2mm。97%的病例狭窄位于食管下三分之一处,3%位于食管中三分之一处。所有病例经内镜检查均发现PES,64%有不同程度的糜烂,20%有溃疡,16%有巴雷特食管。活检样本显示16%有肠化生,75.5%有食管炎,其余8.5%正常。刷检细胞学检查100%病例恶性结果为阴性。食管测压显示蠕动波振幅为40±3mmHg,蠕动波出现率为62±38.6%。LES压力为8.6±6.3mmHg(正常范围24.2±6.3mmHg)。pH值测定显示15%的患者pH值<4。每位患者平均需要4.7±1.6次扩张,87.2%的病例治疗成功。穿孔率占总手术例数的0.1%,占患者的0.7%。死亡率为0.7%(1例)。我们观察到32%的病例出现PES复发。复发与年龄、狭窄持续时间或使用H2受体阻滞剂或质子泵抑制剂的药物治疗之间无相关性。我们得出结论,在阿根廷,PES患者的人口统计学、形态学、功能状态及扩张治疗结果与西方世界报道的相似,但使用H2受体阻滞剂或质子泵抑制剂治疗后的表现有所不同。