Endlicher E, Rümmele P, Beer S, Knüchel R, Rath H, Schlottmann K, Grossmann J, Woenckhaus U, Schölmerich J, Messmann H
Dept. of Internal Medicine I, University of Regensburg, Regensburg, Germany.
Endoscopy. 2005 Nov;37(11):1131-5. doi: 10.1055/s-2005-870409.
The diagnosis of Barrett's esophagus at present requires endoscopic and histological confirmation of specialized intestinal metaplasia. This study prospectively analyzed the endoscopic and histological prevalence of Barrett's esophagus and the risk factors for the presence of Barrett's esophagus among patients being treated in an endoscopy unit.
A total of 474 unselected patients (58% men; mean age 52 y) were included in the study. Two biopsy specimens each were taken from below and above the squamocolumnar junction and from the antrum and gastric body. Four-quadrant biopsies were taken every 1-2 cm to confirm a macroscopic suspicion of Barrett's esophagus.
Barrett's esophagus was suspected at endoscopy in 109 patients (23%). Of the 109 patients with endoscopically suspected Barrett's esophagus, only 46 (42%) had the finding confirmed histologically. The sensitivity and specificity for the endoscopic diagnosis of Barrett's esophagus were 62% and 84%, respectively. A multivariate logistic regression analysis identified age (P = 0.0001; odds ratio per life-year 1.087; 95% CI, 1.046-1.139), male sex (P = 0.0020; OR 6.346; 95% CI, 2.094-22.314), and the number of biopsies (P = 0.0025; OR 1.661; 95% CI, 1.247-2.392) as factors associated with evidence of intestinal metaplasia on biopsy.
The striking discrepancy between the endoscopic findings and the histological diagnosis may be due to the focal distribution of intestinal metaplasia. This emphasizes the importance of an adequate biopsy protocol. In addition, better methods of detecting focal islands of intestinal metaplasia that are not visible at conventional endoscopy are needed.
目前巴雷特食管的诊断需要通过内镜检查及组织学检查证实存在特殊型肠化生。本研究前瞻性分析了在内镜检查科室接受治疗的患者中巴雷特食管的内镜及组织学患病率，以及巴雷特食管存在的危险因素。
本研究共纳入474例未经筛选的患者（男性占58%；平均年龄52岁）。分别从鳞柱状上皮交界处下方和上方、胃窦及胃体各取两份活检标本。每隔1 - 2厘米进行四象限活检，以证实肉眼可见的巴雷特食管疑似病变。
109例患者（23%）在内镜检查时被怀疑患有巴雷特食管。在这109例内镜检查疑似巴雷特食管的患者中，只有46例（42%）经组织学检查确诊。巴雷特食管内镜诊断的敏感性和特异性分别为62%和84%。多因素逻辑回归分析确定年龄（P = 0.0001；每增加一岁的比值比为1.087；95%可信区间，1.046 - 1.139）、男性（P = 0.0020；比值比6.346；9%可信区间，2.094 - 22.314）以及活检数量（P = 0.0025；比值比1.661；95%可信区间，1.247 - 2.392）是与活检时肠化生证据相关的因素。
内镜检查结果与组织学诊断之间存在显著差异可能是由于肠化生的局灶性分布。这凸显了适当活检方案的重要性。此外，需要更好的方法来检测常规内镜检查时不可见的局灶性肠化生岛。
