Regression of columnar lined (Barrett's) oesophagus with continuous omeprazole therapy
Regression of columnar lined (Barrett's) oesophagus with continuous omeprazole therapy
复制标题
连续奥美拉唑治疗使柱状食管（巴雷特食管）消退
DOI：
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发表时间：
1993
影响因子：
7.6
通讯作者：
S. Wilkinson
中科院分区：
文献类型：
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作者：
S. Gore;C. Healey;R. Sutton;I. Eyre;M. Gear;N. Shepherd;S. Wilkinson
23 名患有柱状食管（巴雷特食管）的成年患者正在接受长期奥美拉唑治疗，每日 40 毫克。 12 人从未接受过抗反流手术（第 1 组），另外 11 人之前曾植入过 Angelchik 抗反流假体（第 2 组）。内窥镜检查在治疗前六个月、治疗前立即和治疗后六个月、一年和两年进行。每次内窥镜检查时均进行多次标准化活检。两组的结果相似。在 6 个月的磨合期中，柱状粘膜的线性范围在统计上没有显着性增加，但在治疗的两年期间显示出逐渐的、统计上显着性的减少。 Barrett粘膜消退的其他证据包括异常粘膜内出现大量肉眼可见的鳞状岛、微观鳞状岛数量的增加以及鳞柱状交界处异常粘膜的微观鳞状细胞侵犯。组织学评估显示富含磺粘蛋白的肠化生比例有所减少，但这仅在第 1 组中达到统计学显着性。结果证实了酸在巴雷特食管发病机制中的重要性。奥美拉唑可能具有使化生上皮消退的治疗作用。
Twenty‐three adult patients with a columnar lined (Barrett's) oesophagus are being treated with long‐term omeprazole, 40 mg daily. Twelve had never undergone anti‐reflux surgery (Group 1), the other eleven having previously had insertion of an Angelchik anti‐reflux prosthesis (Group 2). Endoscopy was carried out six months before, immediately before and six months, one year and two years into treatment. Multiple and standardized biopsies were taken at each endoscopy. Results from the two groups were similar. During the 6‐month run‐in period there was a statistically non‐significant increase in the linear extent of the columnar mucosa, but this showed a progressive, statistically significant decrease during the two years of treatment. Other evidence for regression of the Barrett's mucosa includes the emergence of large numbers of macroscopic squamous islands within the abnormal mucosa, an increase in the number of microscopic squamous islands, and microscopic squamous encroachment of the abnormal mucosa at the squamocolumnar junction. Histological assessment showed a reduction in the proportion of sulphomucin‐rich intestinal metaplasia, but this only achieved statistical significance in Group 1. The results substantiate the importance of acid in the pathogenesis of Barrett's oesophagus. Omeprazole may have a therapeutic role in bringing about regression of the metaplastic epithelium.