Spechler S J, Zeroogian J M, Antonioli D A, Wang H H, Goyal R K
Department of Medicine, Beth Israel Hospital, Boston, MA 02215.
Lancet. 1994 Dec 3;344(8936):1533-6. doi: 10.1016/s0140-6736(94)90349-2.
Specialised columnar epithelium (SCE), a form of intestinal metaplasia usually found in Barrett's oesophagus, cannot be distinguished endoscopically from normal gastric epithelium. Endoscopists seldom obtain biopsy specimens from a normal-appearing gastro-oesophageal junction, and therefore short segments of SCE in this region may go unrecognised. We studied patients who had short segments of SCE at the gastro-oesophageal junction. All patients scheduled for elective endoscopic examinations in our general endoscopy unit, irrespective of indication, were questioned for symptoms of gastro-oesophageal reflux disease. At endoscopy, severity of oesophagitis was graded, and biopsy specimens obtained from the squamocolumnar junction, irrespective of its appearance or location in the oesophagus. Among 142 patients without endoscopically apparent Barrett's oesophagus, 26 (18%) were found to have SCE. All patients with SCE were white, and the male/female ratio was 1.9. In contrast, non-whites accounted for 14% of the 114 patients without SCE and the male/female ratio was 0.8. The groups did not differ significantly in the frequency of symptoms and endoscopic signs of gastrooesophageal reflux. We conclude that adults frequently have unrecognised segments of SCE at the gastro-oesophageal junction; this may underlie the rising frequency of cancer of the gastrooesophageal junction in the USA and Europe.
特殊柱状上皮（SCE）是一种通常在巴雷特食管中发现的肠化生形式，在内镜下无法与正常胃上皮区分开来。内镜医师很少从外观正常的胃食管交界处获取活检标本，因此该区域的短段SCE可能未被识别。我们研究了胃食管交界处有短段SCE的患者。在我们普通内镜科安排进行择期内镜检查的所有患者，无论其检查指征如何，均被询问有无胃食管反流病症状。在内镜检查时，对食管炎的严重程度进行分级，并从鳞柱状交界处获取活检标本，无论其在食管中的外观或位置如何。在142例内镜下无明显巴雷特食管的患者中，有26例（18%）被发现有SCE。所有有SCE的患者均为白人，男女比例为1.9。相比之下，在114例无SCE的患者中，非白人占14%，男女比例为0.8。两组在胃食管反流症状和内镜表现的发生频率上无显著差异。我们得出结论，成年人胃食管交界处经常存在未被识别的SCE段；这可能是美国和欧洲胃食管交界癌发病率上升的原因。
