Histological findings after routine biopsy at the gastrooesophageal junction
Histological findings after routine biopsy at the gastrooesophageal junction
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DOI：
10.1097/00042737-199911000-00014
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发表时间：
1999-11-01
影响因子：
2.1
通讯作者：
Oberhuber, G
中科院分区：
文献类型：
--
作者：
Peck-Radosavljevica, M;Püspök, A;Oberhuber, G
目的胃镜活检是胃食道反流病的重要诊断手段。然而，目前尚不清楚肠化生、鳞状上皮增生症和心脏炎等组织学表现是否会影响患者的治疗，以及是否应该在胃-食道交界处进行常规活检。为各种适应症而进行常规胃镜检查的患者在胃-食道交界处正下方、正上方和正上方分别进行两次活组织检查。方法对临床症状、内窥镜下食管炎和组织病理学，如心脏炎、反流性疾病和肠化生进行分级。结果上皮样增生提示反流性疾病(63%)、慢性心脏炎(94%)、活动性心脏炎(40%)、胃凹增生(75%)、肠化生最常见(14%)。在Z线正常的病例中，贲门肠化生与胃肠上皮化生的相关性较弱(Spearman‘s R=0.2P=0.008)，而与慢性或活动期贲门炎及食道上皮化生均无相关性。幽门螺杆菌感染状态和反流病症状与上皮细胞增生之间无相关性。慢性和活动性心脏炎的严重程度与幽门螺杆菌感染状况密切相关(R=0.37P<；0.00001)。30名对照组患者胃镜检查的中位时间为4.6min，而胃镜检查加胃-食道交界处活检的中位时间为8min(U检验，P<；0.00001)。结论胃-食道交界处的肠化生发生的频率太高，不值得在监测计划中定期随访。上皮细胞增生与反流病症状的相关性很差，我们建议在证明对患者处理的影响之前，不应在胃-食道交界处进行常规活检。(C)1999年，Lippincott Williams&Wilkins。
Objective Endoscopy with biopsy is an important diagnostic procedure in patients with gastro-oesophageal reflux disease. However, it is still unclear whether histological findings such as intestinal metaplasia, squamous epithelial hyperplasia, and carditis should have an impact on patient management, and whether routine biopsies at the gastro-oesophageal junction should be taken.Design Patients undergoing routine gastroscopy for various indications were biopsied twice just below, directly at, and right above the gastro-oesophageal junction.Methods Clinical symptoms, endoscopic oesophagitis, and histopathologies such as carditis, reflux disease, and intestinal metaplasia were determined and graded.Results Epithelial hyperplasia suggestive of reflux disease (63%), chronic carditis (94%), active carditis (40%), foveolar hyperplasia (75%), and intestinal metaplasia (14%) were frequently observed. For patients with a normal appearing Z-line, there was a weak correlation of intestinal metaplasia at the cardia with intestinal metaplasia in the stomach (Spearman's R = 0.2, P = 0.008), but no correlation with either chronic or active carditis, or with epithelial hyperplasia in the oesophagus. There was no correlation between H. pylori status or symptoms of reflux disease with epithelial hyperplasia. The severity of chronic and active carditis was closely correlated with H. pylori status (R = 0.37, P < 0.00001). The median time for gastroscopy in 30 control patients was 4.6 min, while endoscopy with additional biopsies at the gastrooesophageal junction took a median of 8 min (U-test, P < 0.00001).Conclusions intestinal metaplasia at the gastro-oesophageal junction was encountered too frequently to warrant regular follow-up in a surveillance programme. Correlation of epithelial hyperplasia with symptoms of reflux disease is poor, We propose that routine biopsy at the gastro-oesophageal junction is not warranted until an impact on patient management can be demonstrated. (C) 1999 Lippincott Williams & Wilkins.