Hassall E
Department of Pediatrics, University of British Columbia, Vancouver, Canada.
Am J Gastroenterol. 1993 Jun;88(6):819-24.
Barrett's esophagus (BE) is a premalignant condition in which metaplastic specialized columnar epithelium with goblet cells is present in the tubular esophagus. BE is much more prevalent in adults than in children, but largely because of its occurrence in children, a congenital etiology for BE has been proposed by some. However, there is extensive, compelling evidence to indicate that Barrett's specialized metaplasia is an acquired disorder in children and adults, resulting from both a severe mucosal injury and an abnormal intraesophageal milieu during mucosal repair. Acid reflux has been emphasized as being the usual inciting and ongoing injurious factor, but more recently the additional importance of refluxed duodenal contents has been recognized. Despite recent advances in our understanding, it remains unclear why pathologic gastroesophageal reflux results in squamous esophagitis in some persons and Barrett's specialized metaplasia in others. Although the evidence cited for a purely congenital cause of BE can be readily refuted, a congenital component in combination with severe mucosal injury cannot be ruled out.
巴雷特食管（BE）是一种癌前病变，其中在管状食管中存在具有杯状细胞的化生特殊柱状上皮。BE在成年人中比在儿童中更为普遍，但很大程度上由于其在儿童中的发生，一些人提出了BE的先天性病因。然而，有大量令人信服的证据表明，巴雷特特殊化生在儿童和成人中都是一种后天性疾病，是由严重的黏膜损伤和黏膜修复过程中异常的食管内环境所致。酸反流一直被强调为常见的诱发和持续损伤因素，但最近已认识到反流的十二指肠内容物的额外重要性。尽管我们在认识上取得了最新进展，但仍不清楚为什么病理性胃食管反流在一些人身上导致鳞状食管炎，而在另一些人身上导致巴雷特特殊化生。虽然有证据表明BE有纯粹先天性病因很容易被反驳，但不能排除先天性因素与严重黏膜损伤相结合的情况。
