DeMeester S R
Department of Surgery, University of Southern California, Los Angeles 90033, USA.
Semin Thorac Cardiovasc Surg. 1997 Jul;9(3):279-84.
Barrett's esophagus is a condition in which intestinal metaplasia replaces a portion of the normal squamous epithelium lining the distal esophagus. It occurs as a consequence of chronic gastroesophageal reflux. Patients with Barrett's often have both lower esophageal sphincter dysfunction and impaired esophageal body motility, and therefore tend to have relatively severe reflux. In addition, it is likely that the composition of refluxed material is important in patients with Barrett's. There is increasing evidence that Barrett's and complications of Barrett's are related to duodenogastric rather than pure gastric reflux. By allowing continued duodenogastric reflux, acid suppression therapy may promote the development of Barrett's. On the other hand, a functioning fundoplication abolishes reflux, ends repetitive injury to the esophageal mucosa, and is associated with a decreased incidence of disease progression in patients with Barrett's compared with medical therapy. Barrett's is a premalignant condition, and all patients should undergo routine endoscopic surveillance. Patients with adenocarcinoma detected while on surveillance present at an earlier stage and have better survival than patients who present outside a surveillance program. In the future, mucosal ablation techniques may allow removal of the metaplastic epithelium and eliminate the risk of malignancy.
巴雷特食管是一种肠化生取代食管远端正常鳞状上皮的疾病。它是慢性胃食管反流的结果。巴雷特食管患者通常同时存在食管下括约肌功能障碍和食管体部运动功能受损，因此往往有相对严重的反流。此外，对于巴雷特食管患者，反流物质的成分可能也很重要。越来越多的证据表明，巴雷特食管及其并发症与十二指肠-胃反流而非单纯的胃反流有关。通过持续允许十二指肠-胃反流，抑酸治疗可能会促进巴雷特食管的发展。另一方面，有效的胃底折叠术可消除反流，终止对食管黏膜的反复损伤，与药物治疗相比，巴雷特食管患者疾病进展的发生率降低。巴雷特食管是一种癌前病变，所有患者都应接受常规内镜监测。在监测期间发现的腺癌患者比未参加监测计划而出现症状的患者处于更早阶段，生存率更高。未来，黏膜消融技术可能允许切除化生上皮并消除恶性肿瘤风险。
