Paull A, Trier J S, Dalton M D, Camp R C, Loeb P, Goyal R K
N Engl J Med. 1976 Aug 26;295(9):476-80. doi: 10.1056/NEJM197608262950904.
To define the histology of the columnarlined esophagus, we obtained esophageal biopsies from various levels with manometric control from 11 patients. There were three types of columnar epithelia above the lower esophageal sphincter: atrophic gastric-fundic-type epithelium with parietal and chief cells; junctional-type epithelium with cardiac mucous glands; and distinctive specialized columnar epithelium with a villiform surface, mucous glands and intestinal-type goblet cells. When present, specialized columnar epithelium was always the most proximal, and gastric fundic epithelium the most distal epithelium. Junctional epithelium was interposed between gastric fundic and specialized columnar or squamous epithelium. Four patients had unequivocal esophagitis in squamous epithelium, but its presence and severity did not correlate with inflammation in or length or type of distal columnar epithelium. Histoligic study of the columnar-lined esophagus demonstrated a spectrum of epithelial patterns. This heterogeneity helps to explain prior discrepant reports.
为明确柱状上皮食管的组织学特征，我们对11例患者不同水平的食管进行活检，并同时进行测压控制。食管下括约肌上方存在三种类型的柱状上皮：含有壁细胞和主细胞的萎缩性胃底型上皮；含有贲门黏液腺的交界型上皮；以及具有绒毛状表面、黏液腺和肠型杯状细胞的独特的特殊柱状上皮。特殊柱状上皮一旦出现，总是位于最近端，而胃底上皮则位于最远端。交界型上皮介于胃底上皮与特殊柱状上皮或鳞状上皮之间。4例患者的鳞状上皮存在明确的食管炎，但食管炎的存在及严重程度与远端柱状上皮的炎症、长度或类型无关。对柱状上皮食管的组织学研究显示了一系列上皮模式。这种异质性有助于解释先前相互矛盾的报告。
