Barrett esophagus
Barrett esophagus
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DOI：
10.1097/00001574-200407000-00013
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发表时间：
2004-07-01
影响因子：
2.5
通讯作者：
Sharma, P
中科院分区：
文献类型：
--
作者：
Bonino, JA;Sharma, P
综述的目的在过去的一年里，为了确定降低食管腺癌死亡率的方法，已经取得了一些进展。这需要对其发生的危险因素Barrett食道有透彻的了解。本文总结了过去一年有关Barrett食道的流行病学、筛查、发病机制、监测和治疗方面的最新和重要的进展。最近的发现过去一年有关Barrett食道的大部分文献集中在选择将从筛查和监测方案中获益最大的患者亚群。年龄增加、胃灼热症状、Barret段长度增加和男性性别等危险因素越来越多地被认为是增加食道恶变的风险。使用较小内窥镜的新技术可能会在选定的患者群体中进行更具成本效益的筛查。亚甲基蓝因其在内窥镜检查中辅助识别Barrett食道的效用而继续被人们接受。最近，一些人对亚甲基蓝的继发性DNA损伤提出了一些担忧，但这一点的临床意义尚不清楚。高倍内窥镜检查以确定某些粘膜模式，表明Barrett食道也得到了接受，也许可以对患有这种疾病的患者进行更准确的监测。关于Barrett食道的治疗以预防食管腺癌的发展仍有许多争议。数据报告可能显示外科抗反流治疗在降低腺癌风险方面有一些优势，但最近的一项荟萃分析驳斥了这一说法。导致肿瘤抑制功能障碍的染色体异常继续被揭示。摘要在过去的一年里，Barrett食道的诊断、监测和治疗取得了许多新进展。对于医生来说，重要的是要意识到这些发展，确定可以采取干预措施的个体，以降低食管腺癌的发展风险。
Purpose of reviewStrides have been made in the past year to identify means of decreasing mortality from esophageal adenocarcinoma. This requires a thorough understanding of the risk factor for its development, Barrett esophagus. This article summarizes the most up-to-date and important advancements involving the epidemiology, screening, pathogenesis, surveillance, and treatment of Barrett esophagus over the past year.Recent findingsMuch of the literature over the past year involving Barrett esophagus centered on selecting subsets of patients who would benefit most from screening and surveillance protocols. Risk factors such as increasing age, heartburn symptoms, increasing length of Barret's segment, and male sex are increasingly identified as increasing the risk for malignant esophageal transformation. New technologies, using smaller endoscopes, may allow more cost-effective screening in selected patient populations. Methylene blue continues to grow in acceptance for its utility in assisting identification of Barrett esophagus during endoscopy. Some concern has been raised recently about DNA damage secondary to the use of methylene blue, but the clinical significance of this is unknown. High-magnification endoscopy to identify certain mucosal patterns suggesting Barrett esophagus is also gaining acceptance, perhaps allowing more accurate surveillance in patients with this condition. Much controversy continues regarding the treatment of Barrett esophagus to prevent the development of esophageal adenocarcinoma. Data reports may show some advantage of surgical antireflux therapy in reducing the risk of adenocarcinoma, but a recent meta-analysis disputes this claim. Chromosomal abnormalities resulting in tumor suppressor dysfunction continue to be revealed.SummaryThe past year has brought many new advances involving the diagnosis, surveillance, and treatment of Barrett esophagus. It is important for physicians to be aware of these developments, to identify individuals in whom interventions may be undertaken to decrease the risk of the development of esophageal adenocarcinoma.