食管及食管胃交界部的特殊肠化生、发育异常和癌症：患病率及临床数据。
Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data.
作者信息
Hirota W K, Loughney T M, Lazas D J, Maydonovitch C L, Rholl V, Wong R K
机构信息
Walter Reed Army Medical Center Gastroenterology Division, Washington, DC, USA.
出版信息
Gastroenterology. 1999 Feb;116(2):277-85. doi: 10.1016/s0016-5085(99)70123-x.
BACKGROUND & AIMS: Adenocarcinoma of the esophagus and esophagogastric junction (EGJ) is increasing, the earliest lesion being specialized intestinal metaplasia (SIM). This study determined the prevalence and demographic features of patients with SIM, dysplasia, and cancer in the esophagus and EGJ.
METHODS
Two antegrade biopsy specimens were taken distal to the squamocolumnar junction (SCJ) and any tongues of pink mucosa proximal to the SCJ. Patients were categorized endoscopically and histologically as having long-segment (LSBE) or short-segment Barrett's esophagus (SSBE), EGJ-SIM, or a normal EGJ.
RESULTS
Of 889 patients studied, 56 were undergoing esophagoduodenoscopy screening or surveillance and were not included in the prevalence calculation. The overall prevalence of SIM was 13.2%, with 1.6% LSBE, 6.0% SSBE, and 5.6% EGJ-SIM. Dysplasia or cancer was noted in 31% of LSBE, 10% of SSBE, and 6.4% of EGJ-SIM patients (P </= 0.043). Two cancers were associated with LSBE, 1 with SSBE, and 1 with EGJ-SIM. Patients with LSBE and SSBE were predominantly white (P </= 0.001), male (P </= 0. 009), and smokers (P </= 0.004), with LSBE patients having a longer history of heartburn (P </= 0.009). In contrast, patients with EGJ-SIM were similar in gender and ethnicity to the reference group, tended to be older (P </= 0.05), drank less alcohol (P </= 0.02), and had a higher prevalence of Helicobacter pylori infection (P </= 0.05).
CONCLUSIONS
The prevalence of SSBE and EGJ-SIM is similar, but each entity is 3.5 times more prevalent than LSBE. However, the prevalence of dysplasia in LSBE is 2 times greater than in SSBE and 4 times greater than in EGJ-SIM. Demographically, EGJ-SIM patients are different from patients with Barrett's esophagus and have a higher prevalence of H. pylori infection. These data help to explain the increasing incidence of adenocarcinoma of the distal esophagus and EGJ.
背景与目的
食管及食管胃交界（EGJ）腺癌的发病率呈上升趋势，最早的病变为特殊型肠化生（SIM）。本研究确定了食管及EGJ处SIM、发育异常和癌症患者的患病率及人口统计学特征。
方法
在鳞柱状交界（SCJ）远端及SCJ近端任何粉红色黏膜舌状突起处取两份顺行活检标本。根据内镜和组织学检查结果，将患者分为长段Barrett食管（LSBE）、短段Barrett食管（SSBE）、EGJ-SIM或正常EGJ。
结果
在研究的889例患者中，56例正在接受食管十二指肠镜筛查或监测，未纳入患病率计算。SIM的总体患病率为13.2%，其中LSBE占1.6%，SSBE占6.0%，EGJ-SIM占5.6%。LSBE患者中31%存在发育异常或癌症，SSBE患者中为10%，EGJ-SIM患者中为6.4%（P≤0.043）。2例癌症与LSBE相关，1例与SSBE相关，1例与EGJ-SIM相关。LSBE和SSBE患者主要为白人（P≤0.001）、男性（P≤0.009）且为吸烟者（P≤0.004），LSBE患者烧心病史更长（P≤0.009）。相比之下，EGJ-SIM患者在性别和种族方面与参照组相似，年龄偏大（P≤0.05），饮酒较少（P≤0.02），幽门螺杆菌感染率较高（P≤0.05）。
结论
SSBE和EGJ-SIM的患病率相似，但均是LSBE的3.5倍。然而，LSBE中发育异常的患病率是SSBE的2倍，是EGJ-SIM的4倍。在人口统计学方面，EGJ-SIM患者与Barrett食管患者不同，幽门螺杆菌感染率较高。这些数据有助于解释远端食管及EGJ腺癌发病率上升的原因。
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