Mayrand S
Department of Medicine, McGill University, Montreal, Quebec.
Can J Gastroenterol. 1997 Sep;11 Suppl B:98B-102B.
Barrett's esophagus represents the most serious consequence of chronic gastroesophageal reflux disease (GERD), primarily because of its association with an increased incidence of esophageal adenocarcinoma. Specific therapy for Barrett's esophagus should lead to the complete regression of the metaplastic epithelium with adequate squamous reepithelialization. Ideally, this regression should be permanent and be associated with a reduction in the incidence of adenocarcinoma. Several reports in the literature have assessed the effects of H2-blocker treatment of Barrett's epithelium, but none has clearly documented a significant and consistent regression of the metaplastic epithelium. Proton pump inhibitors have been shown to be superior to H2 blockers in the treatment of patients with severe esophagitis. Despite initial enthusiasm, it does not appear that a significant regression of Barrett's epithelium can be achieved, even with high doses of proton pump inhibitors given for a prolonged period of time. Various groups have assessed the effects of antireflux surgery on the regression of columnar epithelium and dysplasia and its potential protective effect on the subsequent development of carcinoma. Overall, it appears from these reports that antireflux surgery, despite adequate symptomatic results, does not significantly and consistently lead to a reduction in length or disappearance of the Barrett's mucosa, and does not prevent the development of dysplasia and its progression to carcinoma. More recently, numerous authors have documented the regression of Barrett's mucosa by using various endoscopic thermal modalities. Technological advances including laser and photodynamic therapy have allowed for endoscopic mucosal ablation. Long term results are more encouraging when this mucosal ablation is associated with aggressive antireflux therapy (medical or surgical). Further studies are required before these exciting new therapies can be recommended. Currently, none of these approaches can obviate the need for continued endoscopic surveillance.
巴雷特食管是慢性胃食管反流病（GERD）最严重的后果，主要是因为它与食管腺癌发病率的增加有关。巴雷特食管的特异性治疗应使化生上皮完全消退，并伴有适当的鳞状上皮再上皮化。理想情况下，这种消退应该是永久性的，并且与腺癌发病率的降低相关。文献中的几篇报道评估了H2受体阻滞剂治疗巴雷特上皮的效果，但没有一篇明确记录化生上皮有显著且持续的消退。在治疗严重食管炎患者方面，质子泵抑制剂已被证明优于H2受体阻滞剂。尽管最初人们对此充满热情，但即使长时间给予高剂量的质子泵抑制剂，似乎也无法使巴雷特上皮显著消退。多个研究小组评估了抗反流手术对柱状上皮消退和发育异常的影响及其对后续癌症发生的潜在保护作用。总体而言，从这些报道来看，尽管抗反流手术有足够的症状改善效果，但并不能显著且持续地导致巴雷特黏膜长度缩短或消失，也不能预防发育异常的发生及其进展为癌症。最近，许多作者记录了使用各种内镜热疗方式使巴雷特黏膜消退的情况。包括激光和光动力疗法在内的技术进步使得内镜黏膜切除术成为可能。当这种黏膜切除术与积极的抗反流治疗（药物或手术）相结合时，长期结果更令人鼓舞。在推荐这些令人兴奋的新疗法之前，还需要进一步研究。目前，这些方法都无法消除持续进行内镜监测的必要性。
