Ressetta G, Ziza F, La Bruna D, Cortale M, Melato M, Bucconi S
Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Trieste.
Ann Ital Chir. 1995 Nov-Dec;66(6):831-7; discussion 838.
Chronic, severe reflux esophagitis can be complicated with an esophageal ulcer (EU), whose histomorphological characteristics change sensibly. Between 1983 and 1989, 18 EU were endoscopically identified in 13 (6%) out of 217 patients with chronic gastroesophageal reflux (GER). 2 groups were defined: EU and esophagitis, without columnar-lined esophagus and EU with localized columnar metaplasia or Barrett's esophagus. In the first, 4 Wolf's ulcers (WU) were present; in the second, there were 8 Barrett's ulcers (BU), 2 Savary's ulcers (SU) and 4 ulcers with intermediary characteristics (IU). The 24 h esophageal Ph monitoring demonstrated the reflux pathogenesis in all the patients (57%: alkaline reflux). The histomorphological findings of the EU could support the hypotesis that their variety is related to the different stage of the reflux disease. The EU, started as a peptic lesion on a stratified squamous mucosa (WU), due to an acid, alkaline or mixed reflux, would macroscopically turn into a BU, through intermediary entities (SU, IU), with a progressive extension of columnar metaplasia to the adjacent epithelium and walls. It's not possible to exclude the primitive development of the BU in a Barrett's mucosa, because of an alkaline reflux or because of a low mucosa's resistance (specialized columnar epithelium) to a prolonged acid exposure.
慢性重度反流性食管炎可并发食管溃疡（EU），其组织形态学特征有明显变化。1983年至1989年间，在217例慢性胃食管反流（GER）患者中，有13例（6%）经内镜检查发现18处食管溃疡。分为两组：无柱状上皮化生的食管溃疡和食管炎，以及伴有局限性柱状上皮化生或巴雷特食管的食管溃疡。第一组有4处沃尔夫溃疡（WU）；第二组有8处巴雷特溃疡（BU）、2处萨瓦里溃疡（SU）和4处具有中间特征的溃疡（IU）。24小时食管pH监测证实所有患者均存在反流发病机制（57%为碱性反流）。食管溃疡的组织形态学发现支持这样一种假说，即其类型与反流疾病的不同阶段有关。食管溃疡最初是分层鳞状黏膜上的消化性病变（WU），由于酸、碱或混合反流，宏观上会通过中间实体（SU、IU）转变为巴雷特溃疡，柱状上皮化生逐渐扩展至相邻上皮和管壁。由于碱性反流或由于黏膜（特化柱状上皮）对长时间酸暴露的抵抗力较低，无法排除巴雷特黏膜中巴雷特溃疡的原始发生。
