The ringed esophagus: histological features of GERD
The ringed esophagus: histological features of GERD
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环状食管：GERD 的组织学特征
DOI：
10.1111/j.1572-0241.2001.03682.x
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发表时间：
2001
影响因子：
9.8
通讯作者：
J. Richter
中科院分区：
文献类型：
--
作者：
B. Morrow;J. Vargo;J. Goldblum;J. Richter
目的：“环形”或“波纹”食管是年轻男性慢性吞咽困难和反复食物嵌塞的原因。以前认为这是一种先天性疾病，但最近的病例系列记录了这些患者的组织学食管炎。我们治疗了 19 名环状食管患者，令人印象深刻的是，这是一种以胃食管反流病 (GERD) 为病因的后天性疾病。我们的目标是提出迄今为止最大的环状食管病例系列，讨论 GERD 的证据，并提出诊断和治疗策略。方法：回顾了 19 名环状食管患者的病历。一名病理学家解释了所有可用的食管活检标本，并对它们是否存在 GERD 相关异常进行了分级。进行电话访谈以评估对治疗的反应并确认从病历中获得的历史特征。 结果：典型患者是一名年轻男性（中位年龄 35 岁，男：女 17：2），患有长期吞咽困难和多次食物嵌塞。内窥镜检查显示，尽管有充气，但多个同心环仍然存在，并导致明显的狭窄。在 11 名具有可用组织学特征的患者中，全部有基底细胞增生、乳头状瘤病和上皮内嗜酸性粒细胞数量增加。 GERD 的其他临床特征，如胃灼热、内镜下食管炎和食管裂孔疝，通常不存在。对扩张和抑酸的反应良好。结论：组织学食管炎的一致存在，伴有上皮内嗜酸性粒细胞、基底细胞增生和乳头延长，强烈提示 GERD 与成人环状食管的发病机制有关。除了一系列逐渐的食管扩张之外，我们建议使用质子泵抑制剂来抑制酸。
OBJECTIVE:The “ringed” or “corrugated” esophagus is a cause of chronic dysphagia and recurrent food impactions in young men. It was previously believed to be a congenital condition, but recent case series have documented histological esophagitis in these patients. We have treated 19 patients with a ringed esophagus and are impressed that this represents an acquired condition with gastroesophageal reflux disease (GERD) as its etiology. Our goals are to present the largest case series to date of ringed esophagus, discuss the evidence for GERD, and suggest a strategy for its diagnosis and management.METHODS:The charts of 19 patients with a ringed esophagus were reviewed. A single pathologist interpreted all available esophageal biopsy specimens and graded them for the presence of GERD-related abnormalities. Phone interviews were conducted to assess response to therapy and confirm historical features obtained from medical records.RESULTS:The typical patient is a young man (median age 35, M:F 17:2) with long-standing dysphagia and multiple food impactions. Endoscopy revealed multiple concentric rings that persisted despite air insufflation and caused significant stenosis. Of the 11 patients with available histology, all had basal cell hyperplasia, papillomatosis, and an increased number of intraepithelial eosinophils. Other clinical features of GERD such as heartburn, endoscopic esophagitis, and hiatal hernia were often absent. Response to dilation and acid suppression was good.CONCLUSIONS:The uniform presence of histological esophagitis with intraepithelial eosinophils, basal cell hyperplasia, and papillary lengthening strongly implicates GERD in the pathogenesis of the adult ringed esophagus. In addition to a series of gradual esophageal dilations, we suggest using a proton pump inhibitor to provide acid suppression.