Bozymski E M, Herlihy K J, Orlando R C
Ann Intern Med. 1982 Jul;97(1):103-7. doi: 10.7326/0003-4819-97-1-103.
Barrett's esophagus denotes the presence of columnar epithelium in the esophagus instead of the usual stratified squamous epithelium. Barrett's esophagus had been thought to represent a mediastinal extension of the stomach in patients with a congenital short esophagus. Subsequent clinical and experimental data have established the abnormality as an acquired condition resulting from chronic gastroesophageal reflux. Although roentgenographic studies may show a mild-esophageal stricture or an esophageal ulcer, definitive diagnosis requires endoscopy with directed biopsy of erythematous mucosa in the esophagus, or manometrically guided biopsies for showing the presence of columnar epithelium above the lower esophageal sphincter. Although the origin of the cells causing this epithelium is still unclear, three distinct epithelial types have been found: atrophic gastric-fundic, junctional, and specialized columnar. Esophageal strictures and esophageal ulcers are complications associated with Barrett's esophagus, but its major significance is the association with the development of adenocarcinoma of the esophagus. Treatment of Barrett's esophagus is aimed at preventing gastroesophageal reflux with the additional need for close endoscopic surveillance for the development of dysplasia or early adenocarcinoma. Whether the diagnosis of Barrett's esophagus mandates anti-reflux surgery (fundoplication) remains controversial.
巴雷特食管是指食管中存在柱状上皮而非通常的复层鳞状上皮。巴雷特食管曾被认为是先天性短食管患者胃的纵隔延伸。随后的临床和实验数据已证实这种异常是由慢性胃食管反流导致的后天性疾病。尽管X线检查可能显示轻度食管狭窄或食管溃疡，但明确诊断需要进行内镜检查并对食管红斑黏膜进行定向活检，或通过测压引导活检以显示食管下括约肌上方存在柱状上皮。尽管导致这种上皮的细胞来源仍不清楚，但已发现三种不同的上皮类型：萎缩性胃底型、交界型和特殊柱状型。食管狭窄和食管溃疡是与巴雷特食管相关的并发症，但其主要意义在于与食管腺癌的发生有关。巴雷特食管的治疗旨在预防胃食管反流，另外还需要密切进行内镜监测以发现发育异常或早期腺癌。巴雷特食管的诊断是否需要进行抗反流手术（胃底折叠术）仍存在争议。
