十二指肠胃黏膜异位症的内镜表现及临床特点

Endoscopic clinical characteristics of heterotopic gastric mucosa in duodenum

目的十二指肠胃黏膜异位(HGM)是一种较少见的先天性胚胎残余病变,患者多表现为功能性消化不良(FD)或慢性胃炎症状,临床上容易漏诊。该实验通过对135例十二指肠球部胃黏膜异位症病例的分析,探讨其临床诊疗特点。方法有FD或慢性胃炎症状行胃镜检查患者,发现十二指肠HGM病变行内镜切除并作病理检查,分析幽门螺杆菌(Hp)感染情况,并采用Glasgow评分对治疗前后进行症状评分。结果 4 650例胃镜检查患者中,发现十二指肠HGM患者134例,胃镜检出率为2.9%。患者主要表现上腹隐痛不适、反酸或腹胀等症状。按罗马Ⅲ标准分类,其中符合餐后不适综合征(PDS)者92例(69.2%)、上腹痛综合征(EPS)43(31.8%)。内镜检查发现,十二指肠HGM主要位于十二指肠球部(93.3%),降段较为少见(6.7%)。形态上主要分为4种类型:以多发结节样隆起最为多见,占57%;其次为单发息肉或多发颗粒状隆起(34.1%)。少见的还有溃疡及肿块型,分别占6.7%和2.2%。这两型由于形态不典型,极易误诊为消化性溃疡或肿瘤。超声内镜(EUS)对不典型的十二指肠HGM病变的鉴别诊断有意义,表现为黏膜下层低回声光团,内有无回声区,但这些特征有时也易误诊为异位胰腺。内镜下切除十二指肠HGM对症状改善有帮助。结论十二指肠HGM是部分FD或慢性胃炎症状反复发作的原因,内镜下治疗HGM可有效改善患者的症状。

[ Objective ] Heterotopic gastric mucosa （HGM） in duodenum is a rare congenital embryonic residual lesion, and patients always show the symptoms of functional dyspepsia （FD） or chronic gastritis in clinical. As a result, it has a huge misdiagnosis rate. In this paper, we analyzed 135 cases of HGM in duodenum and investigated the characteristics of its diagnosis and treatment. [ Methods ] The patients received gastroscope , who had symptoms of functional dyspepsia （FD） or chronic gastritis and endoscopic resection, pathological examination when HGM in duodenum was found. At the same time, helicobacter pylori （Hp） infection was analyzed and symptom score was recorded before and after treatment using Glasgow score. [Results] In all 4650 patients, there were 135 patients （2.9%） who were diagnosed of HGM in duodenum. The main symptoms of these patients were epigastrie discomfort, acid reflux, bloating and so on. According to the Rome m standard classification, 92 cases （69.2%） could be diagnosed postprandial distress syndrome （PDS） and 43 （31.8%） epigastrie pain syndrome （EPS）. HGM of the duodenum was mainly located in the duodenal bulb （93.3%） and descending part was rare （6.7%）. The morphology ismainly divided into 4 types： the multiple nodular uplift is the most common （57%）, single polyp or multiple granular uplift （34.1%） are the second, and ulcerative （6.7%） and mess （2.2%） type are rare. The last two types are easily misdiagnosed as peptic ulcer or tumor because their morphology are not typical. It is meaningful to distinguish the atypical HGM using endoscopic ultrasound （EUS）. The performance under the EUS is hypoechoic mass in the submucosa, having anechoic shadow in it, but these characteristics are easily misdiagnosed as ectopic pancreas sometimes. It is helpful for improving the symptom by resecting the HGM under the endoscopy. [ Conclusion ] HGM in duodenum is the reason why the symptoms in part of patients with FD or chronic gastritis attack repeatedly. And it is helpful for improving the symptom by resecting the HGM under the endoscopy.