Clark G W, Ireland A P, Peters J H, Chandrasoma P, DeMeester T R, Bremner C G
Department of Surgery, University of Southern California School of Medicine, Los Angeles, CA 90033-4612, USA.
J Gastrointest Surg. 1997 Mar-Apr;1(2):113-22. doi: 10.1016/s1091-255x(97)80098-4.
The significance of finding specialized intestinal epithelium localized to the region of the gastroesophageal junction is unclear. We tested the hypothesis that short segments of specialized intestinal epithelium are a consequence of gastroesophageal reflux disease and are premalignant. Two hundred forty-one patients with reflux symptoms underwent gastroscopy with rigorous biopsy. Barrett's esophagus was diagnosed when specialized intestinal epithelium was present on biopsy. Patients with Barrett's esophagus were subdivided according to the length of Barrett's mucosa: short-segment Barrett's (<3 cm) and extended Barrett's (> or =3 cm). Esophageal function was evaluated by manometry and 24-hour pH monitoring. In another 16 patients with small noncircumferential adenocarcinomas, the endoscopic length of Barrett's mucosa was recorded. Thirty-three patients (14%) had short-segment Barrett's and 37 (15%) had extended Barrett's esophagus. Patients with short-segment Barrett's esophagus had significantly more acid exposure than patients without specialized intestinal epithelium. Eighty-one percent of patients with short-segment Barrett's esophagus had increased esophageal acid exposure as did 100% of those with extended Barrett's esophagus. All lengths of Barrett's mucosa were associated with poor esophageal sphincter function and reduced contraction amplitudes in the distal esophagus. Twelve percent of patients with short-segment Barrett's esophagus had dysplasia. The length of Barrett's mucosa was > or =3 cm in 25% (4 of 16) of patients with early Barrett's adenocarcinoma. Short-segment Barrett's esophagus is commonly associated with gastroesophageal reflux disease. Further, short segments of specialized intestinal epithelium are premalignant in nature.
在胃食管交界处发现特殊的肠上皮的意义尚不清楚。我们检验了这样一个假设，即短段特殊肠上皮是胃食管反流病的结果且具有癌前病变性质。241例有反流症状的患者接受了胃镜检查并进行了严格活检。活检发现存在特殊肠上皮时诊断为巴雷特食管。巴雷特食管患者根据巴雷特黏膜的长度进行细分：短段巴雷特食管（<3 cm）和长段巴雷特食管（≥3 cm）。通过测压和24小时pH监测评估食管功能。另外16例患有小的非环周腺癌的患者记录了巴雷特黏膜的内镜长度。33例患者（14%）有短段巴雷特食管，37例（15%）有长段巴雷特食管。短段巴雷特食管患者的酸暴露显著多于无特殊肠上皮的患者。81%的短段巴雷特食管患者食管酸暴露增加，长段巴雷特食管患者这一比例为100%。所有长度的巴雷特黏膜均与食管括约肌功能不良及食管远端收缩幅度降低有关。12%的短段巴雷特食管患者有发育异常。在早期巴雷特腺癌患者中，25%（16例中的4例）巴雷特黏膜长度≥3 cm。短段巴雷特食管通常与胃食管反流病相关。此外，短段特殊肠上皮本质上具有癌前病变性质。
