Hassall E, Israel D M, Davidson A G, Wong L T
Division of Pediatric Gastroenterology, British Columbia Children's Hospital, Vancouver, Canada.
Am J Gastroenterol. 1993 Nov;88(11):1934-8.
Barrett's esophagus (BE) is a premalignant condition, and a recognized complication of severe gastroesophageal (GE) reflux. Children with cystic fibrosis (CF) have a marked predilection to develop GE reflux, but Barrett's esophagus is one complication of GE reflux not previously described in CF. We describe in detail two adolescents with CF who were found to have Barrett's esophagus, and mention three other cases. The presence of Barrett's esophagus in CF patients may be missed because GE reflux is often relatively silent in CF, because patients may consider mild upper gastrointestinal (GI) symptoms as "part of CF," and because of the nature of Barrett's epithelium itself. Upper gastrointestinal (GI) endoscopy with documentation of landmarks and multiple targeted biopsies should be performed in children with CF with even mild symptoms of GE reflux or an abnormal 24 h intra-esophageal pH study. Any biopsies containing columnar epithelium should be stained with Alcian blue at pH 2.5 to look for goblet cell metaplasia, i.e., Barrett's esophagus. Children with CF may be a high-risk group for development of Barrett's esophagus and its complications, especially given the increased survival in CF.
巴雷特食管（BE）是一种癌前病变，也是严重胃食管（GE）反流的一种公认并发症。患有囊性纤维化（CF）的儿童极易发生GE反流，但巴雷特食管是CF中以前未曾描述过的GE反流并发症之一。我们详细描述了两名患有CF且被发现患有巴雷特食管的青少年，并提及了其他三例病例。CF患者中巴雷特食管的存在可能会被漏诊，原因在于GE反流在CF中通常相对隐匿，患者可能将轻微的上消化道（GI）症状视为“CF的一部分”，还因为巴雷特上皮本身的特性。对于有哪怕是轻微GE反流症状或24小时食管内pH值研究异常的CF儿童，都应进行上消化道（GI）内镜检查，并记录标志点和进行多次靶向活检。任何含有柱状上皮的活检组织都应用pH值为2.5的阿尔辛蓝染色，以查找杯状细胞化生，即巴雷特食管。CF儿童可能是发生巴雷特食管及其并发症的高危人群，特别是考虑到CF患者生存率的提高。
