Jacobs E, Dehou M F
Edith Cavell Medical Institute, Brussels, Belgium.
Endoscopy. 1997 Oct;29(8):710-5. doi: 10.1055/s-2007-1004294.
The prevalence of endoscopically diagnosed heterotopic gastric mucosa in the upper esophagus (HGMUE) has been reported in a few studies, and varies from 0.1 to 10%. Clinical relevance and possible association with other pathological conditions remain a matter of debate. A prospective study was carried out to determine the prevalence of HGMUE, the influence on it of age and sex, and to study the macroscopic and microscopic aspects of the lesion, its clinical relevance and possible association with other pathological conditions.
A total of 674 new patients with upper digestive complaints or alteration of their state of health underwent upper gastrointestinal endoscopy, with special attention paid to the proximal esophagus when withdrawing the gastroscope. They had been carefully questioned, especially regarding possible complaints, which could have drawn attention to the upper esophagus.
Heterotopic columnar epithelium in the proximal esophagus was found in 4.9 % of patients. No difference was observed according to age or sex. A mild to moderate chronic inflammatory infiltration of the heterotopic patch was observed in most cases, not related to the presence in the lesion of Helicobacter pylori, which was found in only one case. Pathological conditions of the gastroesophageal junction, especially esophagitis, were slightly more frequent in patients with HGMUE. Mild complaints, possibly related to the presence of the lesion, were observed in three out of the 33 cases.
On the basis of our prospective study we consider that heterotopic columnar epithelium in the proximal esophagus is a rather common, generally asymptomatic, benign congenital anomaly. Malignant transformation of heterotopic gastric mucosa in the upper esophagus and other severe complications are rare. The need for surveillance should be reserved for the rare cases with metaplasia or dysplasia in the heterotopic columnar mucosa.
少数研究报道了经内镜诊断的食管上段异位胃黏膜（HGMUE）的患病率，其范围在0.1%至10%之间。其临床相关性以及与其他病理状况的可能关联仍存在争议。开展了一项前瞻性研究，以确定HGMUE的患病率、年龄和性别对其的影响，并研究病变的宏观和微观特征、临床相关性以及与其他病理状况的可能关联。
共有674例有上消化道症状或健康状况改变的新患者接受了上消化道内镜检查，在退出胃镜时特别关注食管近端。对他们进行了仔细询问，尤其关注可能提示食管上段问题的症状。
4.9%的患者在食管近端发现了异位柱状上皮。未观察到年龄或性别差异。大多数病例中观察到异位黏膜有轻度至中度慢性炎症浸润，这与病变中仅1例发现的幽门螺杆菌感染无关。食管胃交界部的病理状况，尤其是食管炎，在HGMUE患者中略为常见。在33例病例中有3例出现了可能与病变存在相关的轻微症状。
基于我们的前瞻性研究，我们认为食管近端的异位柱状上皮是一种相当常见、通常无症状的良性先天性异常。食管上段异位胃黏膜的恶性转化和其他严重并发症很少见。对于异位柱状黏膜出现化生或发育异常的罕见病例，才需要进行监测。
