食管上段胃黏膜异位的病理分型和临床症状特点

Pathological classification and clinical symptoms of heterotopic gastric mucosa in upper esophagus

目的探讨食管上段胃黏膜异位(HGM)的病理分型和临床症状特点。方法选择2018年12月至2019年8月在新疆医科大学第一附属医院行胃镜检查的HGM、反流性食管炎(RE)、Barrett食管和慢性非萎缩性胃炎(CNAG)患者。根据病理分型将HGM分为泌酸型、黏液型、混合型。分析HGM、RE、Barrett食管和CNAG,以及HGM不同病理分型临床症状的差异。采用卡方检验和方差分析进行统计学分析。结果 HGM、RE、Barrett食管、CNAG患者分别为82、104、76、178例。泌酸型、黏液型、混合型HGM患者分别为22、20、40例。HGM患者咽喉部反流症状异物感、吞咽不适、声音嘶哑、咳嗽的发生率均高于RE患者[分别为63.4%(52/82)比14.4%(15/104)、58.5%(48/82)比14.4%(15/104)、50.0%(41/82)比6.7%(7/104)、43.9%(36/82)比12.5%(13/104)],胃食管反流症状反酸、胃灼热、嗳气的发生率均低于RE患者[分别为34.1%(28/82)比61.5%(64/104)、14.6%(12/82)比72.1%(75/104)、34.1%(28/82)比67.3%(70/104)],差异均有统计学意义(χ2=47.80、39.80、44.80、23.30、13.80、60.90、20.20,P均<0.01)。HGM患者咽喉部反流症状异物感、吞咽不适、声音嘶哑、咳嗽的发生率均高于Barrett食管患者[分别为63.4%(52/82)比22.4%(17/76)、58.5%(48/82)比19.7%(15/76)、50.0%(41/82)比9.2%(7/76)、43.9%(36/82)比6.6%(5/76)],而胃食管反流症状反酸、胃灼热、嗳气、胸骨后灼热感的发生率均低于Barrett食管患者[分别为34.1%(28/82)比61.8%(47/76)、14.6%(12/82)比55.3%(42/76)、34.1%(28/82)比65.8%(50/76)、20.7%(17/82)比42.1%(32/76)],差异均有统计学意义(χ2=27.00、24.80、31.00、28.60、12.10、28.90、15.80、8.40,P均<0.01)。HGM患者咽喉部反流症状异物感、吞咽不适、声音嘶哑、咳嗽,胃食管反流症状反酸、胃灼热、嗳气、胸骨后灼热感,以及非反流症状消化不良、腹胀、腹痛的发生率均高于CNAG患者[分别为63.4%(52/82)比5.1%(9/178)、58.5%(48/82)比3.9%(7/178)、50.0%(41/82)比3.9%(7/178)、43.9%(36/82)比4.5%(8/178)、34.1%(28/82)比12.4%(22/178)、14.6%(12/82)比2.8%(5/178)、34.1%(28/82)比3.9%(7/178)、20.7%(17/82)比11.2%(20/178)、30.5%(25/82)比15.2%(27/178)、32.9%(27/82)比14.6%(26/178)、15.9%(13/82)比9.6%(17/178)],差异均有统计学意义(χ2=106.50、100.40、79.10、62.00、17.20、4.10、74.00、12.80、8.20、11.60、2.20,P均<0.01)。泌酸型HGM患者咽喉部反流症状异物感、吞咽不适、声音嘶哑的发生率均高于黏液型[分别为72.7%(16/22)比35.0%(7/20)、72.7%(16/22)比15.0%(3/20)、50.0%(11/22)比20.0%(4/20)],差异均有统计学意义(χ2=6.00、14.10、4.10,P均<0.01);混合型HGM患者咽喉部反流症状异物感、吞咽不适、声音嘶哑、咳嗽的发生率均高于黏液型[分别为72.5%(29/40)比35.0%(7/20)、72.5%(29/40)比15.0%(3/20)、65.0%(26/40)比20.0%(4/20)、62.5%(25/40)比15.0%(3/20)],差异均有统计学意义(χ2=7.80、17.70、10.80、12.10,P均<0.01)。结论临床伴有咽喉部反流症状HGM的病理分型可能为泌酸型或混合型,可服用抑酸药物或行胃镜下氩离子凝固术进一步治疗。

Objective To explore the pathological type and clinical symptoms of heterotopic gastric mucosa in upper esophagus(HGM).Methods From December 2018 to August 2019,at the First Affiliated Hospital of Xinjiang Medical University,the patients with HGM,reflux esophagitis(RE),Barrett esophagus(BE)and chronic non-atrophic gastritis(CNAG),who underwent gastroscopy were selected.The pathological type of HGM including acid secretion,mucinous and mixed type.The differences in the symptoms among HGM,RE,BE,and CNAG,as well as the differences in the clinical symptoms of different pathological types of HGM were analyzed.Chi-square test and analysis of variance were used for statistical analysis.Results There were 82,104,76,and 178 cases of HGM,RE,BE,and CNAG,respectively.The acid secretion,mucinous and mixed types of HGM were 22,20 and 40 cases,respectively.The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat,swallowing discomfort,hoarseness,and cough of HGM patients were higher than those of RE patients(63.4%,52/82 vs.14.4%,15/104;58.5%,48/82 vs.14.4%,15/104;50.0%,41/82 vs.6.7%,7/104;43.9%,36/82 vs.12.5%,13/104),while the incidence rates of gastroesophageal reflux symptoms acid reflux,heartburn and belching were lower than those of RE patients(34.1%,28/82 vs.61.5%,64/104;14.6%,12/82 vs.72.1%,75/104;34.1%,28/82 vs.67.3%,70/104),and the differences were statistically significant(χ2=47.80,39.80,44.80,23.30,13.80,60.90 and 20.20,all P<0.01).The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat,swallowing discomfort,hoarseness,and cough of HGM patients were higher than those of BE patients(63.4%,52/82 vs.22.4%,17/76;58.5%,48/82 vs.19.7%,15/76;50.0%,41/82 vs.9.2%,7/76;43.9%,36/82 vs.6.6%,5/76),and the incidence rates of reflux symptoms acid reflux,heartburn,belching,and post-sternal burning sensation were lower than those of BE patients(34.1%,28/82 vs.61.8%,47/76;14.6%,12/82 vs.55.3%,42/76;34.1%,28/82 vs.65.8%,50/76;20.7%,17/82 vs.42.1%,32/76),and the differences were statistically significant(χ2=27.00,24.80,31.00,28.60,12.10,28.90,15.80 and 8.40,all P<0.01).The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat,swallowing discomfort,hoarseness and cough,gastroesophageal reflux symptoms acid reflux,heartburn,belching and post-sternal burning,and non-reflux symptoms digestion,bloating and abdominal pain of HGM patients were higher than those of CNAG patients(63.4%,52/82 vs.5.1%,9/178;58.5%,48/82 vs.3.9%,7/178;50.0%,41/82 vs.3.9%,7/178;43.9%,36/82 vs.4.5%,8/178;34.1%,28/82 vs.12.4%,22/178;14.6%,12/82 vs.2.8%,5/178;34.1%,28/82 vs.3.9%,7/178;20.7%,17/82 vs.11.2%,20/178;30.5%,25/82 vs.15.2%,27/178;32.9%,27/82 vs.14.6%,26/178;15.9%,13/82 vs.9.6%,17/178),and the differences were statistically significant(χ2=106.50,100.40,79.10,62.00,17.20,4.10,74.00,12.80,8.20,11.60 and 2.20,all P<0.01).The incidence rates of pharyngeal reflux symptoms foreign body sensation,swallowing discomfort,and hoarseness of patients with acid secretion type of HGM were higher than those of mucinous type(72.7%,16/22 vs.35.0%,7/20;72.7%,16/22 vs.15.0%,3/20;50.0%,11/22 vs.20.0%,4/20),and the differences were statistically significant(χ2=6.00,14.10 and 4.10,all P<0.01).The incidence rates of pharyngeal reflux symptoms foreign body sensation in the throat,swallowing discomfort,hoarseness,and cough of mixed type were higher than those of mucinous type(72.5%,29/40 vs.35.0%,7/20;72.5%,29/40 vs.15.0%,3/20;65.0%,26/40 vs.20.0%,4/20;62.5%,25/40 vs.15.0%,3/20),and the differences were statistically significant(χ2=7.80,17.70,10.80 and 12.10,all P<0.01).Conclusions The pathological classification of HGM patients with clinical symptoms of pharyngeal reflux may be acid secretion type or mixed type,which can be treated with acid suppression drugs or argon plasma coagulation under gastroendoscopy.