Sharma P, Morales T G, Bhattacharyya A, Garewal H S, Sampliner R E
Section of Gastroenterology, Tucson VA Medical Center and Arizona Health Sciences Center, 85723, USA.
Am J Gastroenterol. 1998 Mar;93(3):332-5. doi: 10.1111/j.1572-0241.1998.00332.x.
Squamous islands are frequently visualized at the time of upper endoscopy in patients with Barrett's esophagus, especially those on proton pump inhibitor therapy (PPI). The significance of these islands is not clearly understood. The aim of this study was to systematically biopsy macroscopic squamous islands and to examine their histologic characteristics.
Patients with Barrett's esophagus undergoing surveillance had squamous islands documented and biopsied at the time of endoscopy. Barrett's esophagus was defined as the presence of a columnar lined esophagus on endoscopy with intestinal metaplasia on biopsy. All biopsies were obtained by a single senior endoscopist and were stained with alcian blue at pH 2.5. Biopsy samples with inadequate tissue quantity were not included in the study.
A total of 39 biopsies were obtained from 22 patients. Twenty of the 22 patients were male, with a mean age of 65.4 yr (range 47-80 yr). The mean length of Barrett's mucosa was 5.6 cm (range 1-11 cm). Eleven of 22 patients were on omeprazole (mean dose 29.1 mg/day), whereas seven patients were on lansoprazole (60 mg/day). The mean duration of PPI therapy was 2.3 yr (range 9-71 months) at the time of biopsy of the squamous islands. Three patients were on H2-blocker therapy whereas the remaining patient had not been started on acid suppression therapy. On histology, 24 biopsy specimens (61.5%) revealed only squamous epithelium, whereas 15 (38.5%) showed the presence of intestinal metaplasia underlying the squamous epithelium. There was no significant difference between the patients with and without underlying intestinal metaplasia in regard to age, Barrett's length, dose, and duration of PPI therapy.
In more than one-third of biopsies of macroscopic squamous islands within Barrett's esophagus, microscopic intestinal metaplasia is detected. The presence of squamous islands should not be equated with regression of Barrett's esophagus or with decreased cancer risk.
在巴雷特食管患者进行上消化道内镜检查时，常常可以看到鳞状上皮岛，尤其是那些正在接受质子泵抑制剂治疗（PPI）的患者。这些岛状结构的意义尚不清楚。本研究的目的是对宏观鳞状上皮岛进行系统活检，并检查其组织学特征。
接受监测的巴雷特食管患者在内镜检查时记录并活检鳞状上皮岛。巴雷特食管定义为内镜检查时食管出现柱状上皮内衬，活检显示有肠化生。所有活检均由一位资深内镜医师进行，并用pH 2.5的阿尔辛蓝染色。组织量不足的活检样本不纳入本研究。
共从22例患者中获取了39份活检样本。22例患者中有20例为男性，平均年龄65.4岁（范围47 - 80岁）。巴雷特黏膜的平均长度为5.6厘米（范围1 - 11厘米）。22例患者中有11例服用奥美拉唑（平均剂量29.1毫克/天），7例患者服用兰索拉唑（60毫克/天）。在对鳞状上皮岛进行活检时，PPI治疗的平均持续时间为2.3年（范围9 - 71个月）。3例患者接受H2受体阻滞剂治疗，其余患者未开始进行抑酸治疗。组织学检查显示，24份活检标本（61.5%）仅显示鳞状上皮，而15份（38.5%）显示鳞状上皮下方存在肠化生。在年龄、巴雷特食管长度、PPI治疗剂量和持续时间方面，有或无潜在肠化生的患者之间无显著差异。
在巴雷特食管内宏观鳞状上皮岛的活检样本中，超过三分之一检测到微观肠化生。鳞状上皮岛的存在不应等同于巴雷特食管的消退或癌症风险降低。
