Schlottmann Francisco, Patti Marco G, Shaheen Nicholas J
Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, CB#7080, Chapel Hill, NC, 27599-7080, USA.
World J Surg. 2017 Jul;41(7):1698-1704. doi: 10.1007/s00268-017-3957-z.
Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the USA, and its prevalence is increasing worldwide. About 10-15% of patients with GERD will develop Barrett's esophagus (BE).
The aims of this study were to review the available evidence of the pathophysiology of BE and the role of anti-reflux surgery in the treatment of this disease.
The transformation of the squamous epithelium into columnar epithelium with goblet cells is due to the chronic injury produced by repeated reflux episodes. It involves genetic mutations that in some patients may lead to high-grade dysplasia and cancer. There is no strong evidence that anti-reflux surgery is associated with resolution or improvement in BE, and its indications should be the same as for other GERD patients without BE.
Patients with BE without dysplasia require endoscopic surveillance, while those with low- or high-grade dysplasia should have consideration of endoscopic eradication therapy followed by surveillance. New endoscopic treatment modalities are being developed, which hold the promise to improve the management of patients with BE.
据估计，美国约20%的人口患有胃食管反流病（GERD），且其在全球的患病率正在上升。约10%-15%的GERD患者会发展为巴雷特食管（BE）。
本研究的目的是回顾BE病理生理学的现有证据以及抗反流手术在该疾病治疗中的作用。
鳞状上皮向含有杯状细胞的柱状上皮的转变是由反复反流发作产生的慢性损伤所致。这涉及基因突变，在一些患者中可能导致高级别异型增生和癌症。没有强有力的证据表明抗反流手术与BE的消退或改善相关，其适应证应与其他无BE的GERD患者相同。
无异型增生的BE患者需要内镜监测，而低级别或高级别异型增生的患者应考虑内镜根除治疗，随后进行监测。新的内镜治疗方式正在研发中，有望改善BE患者的管理。
