食管癌高发区反流性食管炎患病情况调查

Mass survey for reflux esophagitis on the subjects at high-incidence areas for esophageal cancer in Henan

目的:探讨河南食管癌高发区居民反流性食管炎(RE)的流行病学及组织病理学变化特征。方法:采用RE问卷调查、胃镜黏膜活检和组织病理学检查等技术,分析河南食管癌高发区居民RE变化特征和规律。结果:胃镜检查共发现26例RE患者(26/412,6%),RE洛杉矶分级B级为主(23/26)。412例接受胃镜检查的居民中,327例接受问卷调查,其中RE患者21例;RE最常见的症状依次为烧心(33%),反酸(32%),反胃(30%)。以胃镜检查正常者21例为正常对照,RE患者基底细胞过度增生(BCH)和间变(DYS)的检出率高于正常对照,未检出食管癌、肠上皮化生和Barrett′s食管;RE患者食管下段上皮乳头高度和密度均高于正常对照(P<0.05)。RE患者食管下段黏膜病变组织中嗜酸性粒细胞浸润明显,正常对照无浸润。结论:食管上皮乳头升高和乳头密度增大及嗜酸性粒细胞浸润是RE主要的组织病理学改变,并常伴有BCH和DYS改变以及极少的Barrett′s食管发生率,提示河南食管癌高发区食管贲门交界部腺癌的发生模式可能与西方不同。

Aim ： To characterize the prevalence and histopathological changes of reflux esophagitis （RE） on the mass survey subjects from the high-incldence areas for esophageal cancer in Henan. Methods： RE questionnaire, endoscopic examination, biopsy and histopathological examination were performed on the subjects from the high-incidence area for esophageal cancer to analyze the changes of RE. Results： Twenty-six cases of RE were identified under endoscopy （26/412, 6% ） . LA-B type of RE （23/26） was predominant. Of the 412 subjects with endoscopic examination, 327 subjects accepted questionnaire （including 21 RE cases）. The common symptoms for RE were heartburn （33%） , acid reflux （32%） , and regurgitation （30%）. Regarding 21 cases without RE as control, the detection rate of basal cell hyperplasia （ BCH）, dysplasia （DYS） in cases of RE were higher than those of the control, and no squamous cell carcinoma, intestinal metaplasia and Barrett＇s esophagus were found. The elongation and density of esophageal papillae were apparently higher in RE patients than those in control. Eosinophilic cell infiltration in RE patients was predominant in the lower esophageal segment. Conclusion： Elongation and high density for papilliae and eosinophilic cell infiltration with BCH and DYS are important pathological changes for RE. These results together with low incidence of Barrett＇s esophagus suggest that there may be different mechanisms involved in Chinese subjects for carcinogenesis at the esophageal-gastric junction compared with western countries.