Kouzu T, Yoshimura S, Onuma E K, Hishikawa E, Arima M
Department of Endoscopic Diagnostics and Therapeutics, Chiba University, Japan.
Nihon Geka Gakkai Zasshi. 1998 Sep;99(9):552-7.
Barrett's esophagus (BE) has recently gained the interest of Japanese physicians. In BE, the squamous epithelium of the distal esophagus is replaced by metaplastic columnar epithelium. This intestinal metaplasia usually occurs as a complication of severe reflux esophagitis and its association with adenocarcinoma of the esophagus is well established. In 1950 Norman Barrett described a tubular, intrathoracic structure that appeared to be the esophagus, except that the distal portion was lined with columnar epithelium. Although he believed that the distal portion was not the esophagus, the condition in which the distal esophagus is lined with columnar epithelium became known as BE. From animal and clinical studies, the intestinal metaplasia is generally believed to arise from multipotential stem cells located in the basal layer of the squamous epithelium and at the base of the glandular epithelium. Evidence for a genetic basis underlying the dysplasia-adenocarcinoma sequence is now being accumulated. It is known that gastric acid reflux as well as bile reflux can cause distal esophagitis. Therefore, treatment with a proton pump inhibitor alone may not be sufficient therapy for all patients. Antireflux surgery can cause regression of BE in up to 50% of patients. Overall 1-, 2-, and 5-year survival rates for patients with adenocarcinoma arising from BE after surgical resection is reported to be 63%, 41%, and 32%, respectively. Therefore, endoscopic surveillance of patients with BE is suggested.
巴雷特食管（BE）最近引起了日本医生的关注。在巴雷特食管中，食管远端的鳞状上皮被化生的柱状上皮所取代。这种肠化生通常作为严重反流性食管炎的并发症出现，并且其与食管腺癌的关联已得到充分证实。1950年，诺曼·巴雷特描述了一种管状的胸内结构，它看起来像是食管，只是远端部分内衬柱状上皮。尽管他认为远端部分不是食管，但远端食管内衬柱状上皮的这种情况后来被称为巴雷特食管。从动物和临床研究来看，肠化生一般被认为起源于位于鳞状上皮基底层和腺上皮基部的多能干细胞。目前正在积累有关发育异常 - 腺癌序列潜在遗传基础的证据。已知胃酸反流以及胆汁反流均可导致远端食管炎。因此，仅用质子泵抑制剂治疗可能对所有患者并不足够。抗反流手术可使高达50%的患者的巴雷特食管病情消退。据报道，手术切除后由巴雷特食管引发腺癌的患者的1年、2年和5年总生存率分别为63%、41%和32%。因此，建议对巴雷特食管患者进行内镜监测。
