Csendes A, Smok G, Sagastume H, Rojas J
Departamento de Cirugía, Hospital Clínico, Universidad de Chile, Santiago, Chile.
Rev Med Chil. 1998 Feb;126(2):155-61.
The classic diagnosis of Barret esophagus is based on the finding of three of more cm of distal esophagus covered by specialized columnar epithelium. However, at the present time, it is based on the presence of intestinal metaplasia in the junction of squamous-columnar mucosae.
To assess the prevalence of Barret esophagus using endoscopic and pathological criteria in healthy subjects and in individuals with gastroesophageal reflux.
One hundred thirty nine controls and 372 patients with symptoms of gastroesophageal reflux subjected to an upper gastrointestinal endoscopy were studied. Patients with Barret esophagus were classified as having a "mini Barret" when the pathological presence of intestinal metaplasia was the only finding. A "short Barret esophagus" was diagnosed when less than 3 cm were covered with fingerings of mucosal substitutions and "extensive Barret esophagus" when more than 3 cm of esophageal mucosa were substituted.
Two percent of controls, 12.4% of patients with gastroesophageal reflux without esophagitis and 11.7% of such patients with esophagitis had intestinal metaplasia in the gastroesophageal junction. Patients with Barret esophagus were older than the rest of patients. "Short Barret esophagus" is six times more frequent than "extensive Barret esophagus". Esophageal erosions, peptic ulcers and stenosis were more frequent in patients with extensive Barret esophagus. The prevalence of dysplasia was similar in all types of Barret esophagus.
Intestinal metaplasia was very infrequent in control patients. In subjects with gastroesophageal reflux, classic endoscopic diagnosis may miss up to 80% of patients with Barret esophagus. Thus, gastroesophageal junction biopsies must be obtained in all patients with symptoms of gastroesophageal reflux.
巴雷特食管的经典诊断基于发现食管远端有3厘米或更长的区域被特殊柱状上皮覆盖。然而，目前其诊断基于鳞状柱状黏膜交界处存在肠化生。
采用内镜和病理标准评估健康受试者及胃食管反流患者中巴雷特食管的患病率。
对139名对照者和372名有胃食管反流症状并接受上消化道内镜检查的患者进行研究。当肠化生的病理表现为唯一发现时，巴雷特食管患者被分类为患有“微型巴雷特食管”。当黏膜替代指状物覆盖小于3厘米时诊断为“短段巴雷特食管”，当食管黏膜替代超过3厘米时诊断为“长段巴雷特食管”。
2%的对照者、12.4%无食管炎的胃食管反流患者以及11.7%有食管炎的此类患者在胃食管交界处存在肠化生。巴雷特食管患者比其他患者年龄更大。“短段巴雷特食管”的发生率是“长段巴雷特食管”的6倍。长段巴雷特食管患者中食管糜烂、消化性溃疡和狭窄更为常见。所有类型的巴雷特食管中发育异常的患病率相似。
对照患者中肠化生非常少见。在胃食管反流患者中，经典的内镜诊断可能会漏诊高达80%的巴雷特食管患者。因此，所有有胃食管反流症状的患者都必须进行胃食管交界处活检。
