Neumann C S, Iqbal T H, Cooper B T
Gastroenterology Unit, City Hospital NHS Trust, Birmingham, UK.
Aliment Pharmacol Ther. 1995 Aug;9(4):451-4. doi: 10.1111/j.1365-2036.1995.tb00405.x.
The metaplastic columnar epithelium in Barrett's oesophagus has malignant potential.
To determine whether decreasing acid reflux leads to regression of Barrett's epithelium.
Twenty-four patients with Barrett's oesophagus were treated with omeprazole 20 mg o.m. in an open, prospective study; 11 were treated for 12 months, and 13 for 24 months. Another group of 17 patients with Barrett's oesophagus was treated with an H2-receptor antagonist in standard dosage for 12-36 (mean 23) months. Patients were assessed endoscopically.
No evidence of significant shortening of the length of Barrett's oesophagus was seen in any patient treated for 12 or 24 months with omeprazole. Similarly, no shortening of the length of Barrett's oesophagus was seen in any patient treated with an H2-receptor antagonist. However, 6 of 11 patients treated with omeprazole for 12 months, and 7 of 13 treated for 24 months, developed macroscopic squamous islands visible below the squamo-columnar junction. This was not seen in any patient treated with an H2-receptor antagonist.
Although there can be reappearance of squamous epithelium in Barrett's oesophagus of some patients during treatment with omeprazole 20 mg o.m. over 12-24 months, a significant shortening of the columnar lined segment is not seen.
巴雷特食管中的化生柱状上皮具有恶变潜能。
确定减少胃酸反流是否会导致巴雷特上皮消退。
在一项开放性前瞻性研究中，24例巴雷特食管患者接受口服20mg奥美拉唑治疗；11例治疗12个月，13例治疗24个月。另一组17例巴雷特食管患者接受标准剂量的H2受体拮抗剂治疗12 - 36（平均23）个月。对患者进行内镜评估。
接受奥美拉唑治疗12个月或24个月的任何患者均未发现巴雷特食管长度有明显缩短的证据。同样，接受H2受体拮抗剂治疗的任何患者也未发现巴雷特食管长度缩短。然而，接受奥美拉唑治疗12个月的11例患者中有6例，治疗24个月的13例患者中有7例，在鳞柱状交界处下方出现了肉眼可见的鳞状上皮岛。接受H2受体拮抗剂治疗的患者中未出现这种情况。
尽管在12 - 24个月口服20mg奥美拉唑治疗期间，部分巴雷特食管患者的食管中可再次出现鳞状上皮，但柱状上皮段未见明显缩短。
