Mangla J C, Schenk E A, Desbaillets L, Guarasci G, Kubasik N P, Turner M D
Gastroenterology. 1976 May;70(5 PT.1):669-76.
Four cases of Barrett's esophagus are presented. Three cases presented with significant esophageal bleeding and one case presented with high esophageal stricture. Gastrointestinal panendoscopy was done in each case and multiple biopsies were taken. The biopsies were utilized for histomorphology, pepsinogen agar gel electrophoresis, and tissue gastrin assays. Tissue gastrin levels in esophageal mucosa were elevated in 2 cases when compared to controls with and without hiatus hernia. Pepsin and acid secretory studies were done by isolating the esophagus. Barrett's esophagus was shown to produce pepsin by both chemical studies (2 cases) and agar gel electrophoresis at pH 5.7 (3 cases), and was also shown to produce acid. The mucosa contained either cathepsin or cathepsin and pepsinogens in all cases. Nissen's fundoplication was performed in all of the patients. Of 3 patients who were bleeding, 2 who consented for this operation stopped bleeding after the operation. It is to be noted that the usual clinical treatment of antacids, bedrest, and raising the head end of the bed failed in all of the patients. The follow-up of 9 months to 3 years postoperatively has shown persistence of Barrett's mucosa with no evidence for any reversion to normal esophageal type.
本文报告了4例巴雷特食管病例。其中3例表现为严重的食管出血，1例表现为高位食管狭窄。每例均行胃肠内镜检查并取多处活检。活检标本用于组织形态学、胃蛋白酶原琼脂凝胶电泳及组织胃泌素测定。与有或无食管裂孔疝的对照组相比，2例食管黏膜组织胃泌素水平升高。通过分离食管进行胃蛋白酶和胃酸分泌研究。化学研究（2例）及pH 5.7时的琼脂凝胶电泳（3例）均显示巴雷特食管可产生胃蛋白酶，且也可产生胃酸。所有病例黏膜中均含有组织蛋白酶或组织蛋白酶和胃蛋白酶原。所有患者均行nissen胃底折叠术。3例出血患者中，2例同意手术，术后出血停止。值得注意的是，所有患者采用抗酸剂、卧床休息及抬高床头的常规临床治疗均无效。术后9个月至3年的随访显示，巴雷特黏膜持续存在，无任何恢复为正常食管类型的迹象。
