Morales T G, Sampliner R E, Bhattacharyya A
Arizona Health Sciences Center, Tucson Veteran's Administration Medical Center, USA.
Am J Gastroenterol. 1997 Mar;92(3):414-8.
Although the incidence of gastric adenocarcinoma in the U. S. is declining, the incidence of cancer localized to the gastric cardia has risen dramatically. It is not yet clear whether cancer of the gastric cardia arises from a premalignant lesion such as intestinal metaplasia (IM). The purpose of this study was to determine the prevalence of IM involving the cardia in patients presenting for elective EGD, and evaluate potential associated factors.
During a 7 month period patients referred for elective EGD at the Tucson VA Medical Center were invited to participate in the study. Prior to EGD each patient was surveyed with regard to GERD symptoms and smoking and alcohol history. During EGD note was made of the presence of esophagitis, hiatus hernia, and Barrett's-appearing mucosa. The esophagogastric junction (EGJ) was defined as the end of the tubular esophagus coinciding with the proximal heads of the gastric folds. Seven biopsies were taken from specific sites in the antrum, angularis, cardia, and EGJ. Biopsy specimens were stained with a combination of H & E and Alcian blue at a pH of 2.5. Histologic evidence of IM was defined as columnar-type epithelium including goblet cells staining with Alcian blue. Patients were also evaluated for H. pylori infection by histologic and serologic examinations.
There were 104 patients (99 male, 5 female) with a mean age of 61.6 years. Twenty-four (23%) were found to have IM involving the gastric cardia, although none of these had dysplasia. Eleven patients (11%) had Barrett's esophagus; however, only 2 of these had concomitant IM of the cardia. On the other hand, 9 of the 24 with IM of the cardia had concomitant IM elsewhere in the stomach. Forty-nine patients (47%) were found to be positive for H. pylori infection and there was a significant association between H. pylori infection and IM of the gastric cardia (p = 0.03).
These data show that IM of the gastric cardia is a relatively common finding and is associated with H. pylori infection. Although dysplasia was not identified, long-term follow-up studies will be necessary to determine the incidence of dysplasia or adenocarcinoma developing from IM of the cardia.
尽管美国胃腺癌的发病率在下降，但局限于贲门部的癌症发病率却急剧上升。贲门癌是否起源于诸如肠化生（IM）等癌前病变尚不清楚。本研究的目的是确定接受择期内镜逆行胰胆管造影（EGD）的患者中贲门部肠化生的患病率，并评估潜在的相关因素。
在7个月的时间里，邀请图森退伍军人事务医疗中心转诊接受择期EGD的患者参与研究。在进行EGD之前，对每位患者进行了胃食管反流病（GERD）症状以及吸烟和饮酒史的调查。在EGD过程中，记录食管炎、食管裂孔疝和巴雷特样黏膜的存在情况。食管胃交界（EGJ）定义为管状食管的末端与胃皱襞近端头部相重合处。从胃窦、角切迹、贲门和EGJ的特定部位采集7块活检组织。活检标本用苏木精和伊红（H&E）以及pH值为2.5的阿尔辛蓝进行染色。IM的组织学证据定义为柱状上皮，包括用阿尔辛蓝染色的杯状细胞。还通过组织学和血清学检查对患者进行幽门螺杆菌感染评估。
共有104例患者（99例男性，5例女性），平均年龄61.6岁。发现24例（23%）患者存在贲门部肠化生，不过这些患者均无发育异常。11例患者（11%）有巴雷特食管；然而，其中只有2例同时存在贲门部肠化生。另一方面，24例贲门部肠化生患者中有9例在胃的其他部位同时存在肠化生。49例患者（47%）被发现幽门螺杆菌感染呈阳性，幽门螺杆菌感染与贲门部肠化生之间存在显著关联（p = 0.03）。
这些数据表明，贲门部肠化生是一种相对常见的发现，且与幽门螺杆菌感染有关。尽管未发现发育异常，但需要进行长期随访研究以确定贲门部肠化生发展为发育异常或腺癌的发生率。
