Guenther Thomas, Hackelsberger Andreas, Kuester Doerthe, Malfertheiner Peter, Roessner Albert
Department of Pathology, Otto-von-Guericke University, Leipziger Strasse 44, 39120 Magdeburg, Germany.
Pathol Res Pract. 2007;203(12):831-7. doi: 10.1016/j.prp.2007.09.003.
Metaplastic glandular mucosa with goblet cells at the squamocolumnar junction is induced either by reflux or by Helicobacter infection. We investigated whether the accompanying inflammation may give information about the etiology of these metaplastic changes and whether there are further criteria which are helpful in differentiating Helicobacter-induced vs. reflux-caused metaplasia.
One hundred and nine patients with intestinal metaplasia diagnosed in biopsies obtained immediately below the Z-line were evaluated. Further biopsies were taken from the gastric body and antrum. Patients were diagnosed as having a normal Z-line, or as showing short tongues or segments of Barrett's esophagus endoscopically. Inflammation was graded according to the updated Sydney-system. Metaplasia was typed using Gomori's-aldehyde-fuchsin-Alcianblue staining.
Compared to patients with Barrett's esophagus, the active (p=0.0002) and chronic inflammation (p=0.0004) at the squamocolumnar junction was higher in patients with a normal Z-line and frequently accompanied by lymphoid aggregates (p<0.0001) and regular cardia- (p=0.0044) and/or corpus-type glands (p=0.0004). Pseudogoblet cells were more frequent in Barrett's esophagus (p=0.0159).
The endoscopic aspect of the Z-line, the inflammatory pattern, and the type of glands in biopsies from the squamocolumnar junction, as well as the presence of pseudogoblet cells are helpful tools in distinguishing Barrett's mucosa from Helicobacter-associated intestinal metaplasia.
食管鳞状柱状上皮交界处出现的伴有杯状细胞的化生腺性黏膜，可由反流或幽门螺杆菌感染引起。我们研究了伴随的炎症是否能为这些化生改变的病因提供信息，以及是否存在有助于区分幽门螺杆菌诱导的化生与反流引起的化生的其他标准。
对109例在Z线下方立即获取的活检标本中诊断为肠化生的患者进行评估。从胃体和胃窦取进一步的活检标本。在内镜下，患者被诊断为Z线正常，或显示短舌状或Barrett食管节段。根据更新后的悉尼系统对炎症进行分级。使用Gomori醛复红-阿尔辛蓝染色对化生进行分型。
与Barrett食管患者相比，Z线正常的患者在鳞状柱状上皮交界处的活动性炎症（p=0.0002）和慢性炎症（p=0.0004）更高，且常伴有淋巴滤泡（p<0.0001）以及规则的贲门型（p=0.0044）和/或胃体型腺体（p=0.0004）。假杯状细胞在Barrett食管中更常见（p=0.0159）。
Z线的内镜表现、炎症模式、鳞状柱状上皮交界处活检标本中的腺体类型以及假杯状细胞的存在，都是区分Barrett黏膜与幽门螺杆菌相关肠化生的有用工具。
