食管上段胃黏膜异位症的临床、内镜及组织学特点

Clinical,endoscopic and histological characteristics of heterotopic gastric mucosa in upper esophagus

目的探讨食管上段胃黏膜异位症(heterotopic gastric mucosa in upper esophagus,HGMUE)的临床、内镜和组织学特点。方法2017年1—12月,在华中科技大学同济医学院附属协和医院内镜中心行常规胃镜检查,胃镜下发现食管上段胃黏膜异位斑的177例患者纳入研究,根据胃食管反流症状评分量表(GERD‑Q)评分结果分成2组,即HGMUE组(GERD‑Q<8分,n=101)和HGMUE合并胃食管反流病组(HGMUE^(+)GERD组,GERD‑Q≥8分,n=76),对临床、内镜和病理资料进行汇总和分析。结果177例HGMUE患者中,男111例(62.71%)、女66例(37.29%),合并GERD 76例(42.94%)、未合并GERD 101例(57.06%),持续清嗓的发生率最高[54.24%(96/177)],其次为咽部异物感[48.59%(86/177)]和烧心、胸痛、消化不良、胃酸反流[48.59%(86/177)]。HGMUE组中,持续清嗓的发生率最高[42.57%(43/101)],其次为咽部异物感[33.66%(34/101)]和烧心、胸痛、消化不良、胃酸反流[27.72%(28/101)];HGMUE^(+)GERD组中,烧心、胸痛、消化不良、胃酸反流的发生率最高[76.32%(58/76)],其次为持续清嗓[69.74%(53/76)]和咽部异物感[68.42%(52/76)]。共检出177处食管上段胃黏膜异位斑,胃镜下通常表现为橘红色圆形、椭圆形或长条形的岛状病灶,大多数较平坦、少数稍凸出周边平面,单发132例(74.58%)、2处病灶38例(21.47%)、3处及3处以上病灶7例(3.95%),小病灶(最大直径<0.5 cm)37处(20.90%)、中等大小病灶(最大直径在0.5~1.0 cm)74处(41.81%)、较大病灶(最大直径>1.0 cm)66处(37.29%)。有30例[16.95%(30/177)]接受了活检组织学检查,胃底腺为主型15例[50.00%(15/30)]、幽门腺为主型8例[26.67%(8/30)]、混合型6例[20.00%(6/30)]、剩余1例[3.33%(1/30)]为鳞状上皮,20例[66.67%(20/30)]免疫组化H^(+)/K^(+)‑ATP酶阳性、10例[33.33%(10/30)]免疫组化H^(+)/K^(+)-ATP酶阴性。结论HGMUE多见于男性患者,可合并亦可不合并GERD,其中合并GERD者更易发生咽喉反流。内镜下胃黏膜异位斑多表现为橘红色圆形、椭圆形或长条形的岛状病灶,大多数较平坦,以单发为主,多为中等及较大病灶。组织学分型以胃底腺为主型,免疫组化H^(+)/K^(+)‑ATP酶阳性多见,推测酸分泌可能是导致咽喉症状的重要因素。

Objective To study the clinical,endoscopic and histological characteristics of heterotopic gastric mucosa in upper esophagus(HGMUE).Methods A Total of 177 patients who underwent gastroscopy and were diagnosed as having HGMUE at the Endoscopy Center of Wuhan Union Hospital from January 2017 to December 2017 were included in the study.According to the gastroesophageal reflux disease symptom questionnaire(GERD-Q)scores,patients were divided into the HGMUE group(GERD-Q<8,n=101)and GERD^(+)HGMUE group(GERD-Q≥8,n=76).The data of clinical,endoscopic and histological characteristics were analyzed.Results Among the 177 HGMUE cases,there were 111 males(62.71%)and 66 females(37.29%),76(42.94%)with GERD,and 101(57.06%)without GERD.The most common symptom was continuous clearing throat[54.24%(96/177)],followed by foreign body sensations of throat[48.59%(86/177)],and gastroesophageal reflux symptoms such as heartburn,chest pain,indigestion,acid reflux[48.59%(86/177)].In the HGMUE group,the occurrence rate of clearing throat was the highest[42.57%(43/101)],then foreign body sensations of throat accounted for 33.66%(34/101),and gastroesophageal reflux symptoms was 27.72%(28/101).In the HGUME^(+)GERD group,the most common symptom was gastroesophageal reflux symptoms[76.32%(58/76)],then clearing throat[69.74%(53/76)]and foreign body sensations of throat[68.42%(52/76)].Under gastroscopy,177 heterotopic gastric lesions were found under gastroscopy with orange-red round,oval or elongated island like ones,most of which were flat and a few slightly protruded from the peripheral plane.There were 132(74.58%)single-lesion cases,38(21.47%)2-lesion,and 7(3.95%)3-or more-lesion cases;there were 37(20.90%)small lesions(maximum diameter<0.5 cm),and 74(41.81%)median-size lesions(maximum diameter of 0.5-1.0 cm),and 66(37.3%)larger lesions(maximum diameter>1.0 cm).Among the 30[16.95%(30/177)]samples of mucosal tissue,15[50.00%(15/30)]were mainly cardia gland,8[26.67%(8/30)]were mainly pyloric gland,6[20.00%(6/30)]were mixed type,and 1[3.33%(1/30)]was squamous epithelium.In the immunohistochemical test,20 cases[66.67%(20/30)]showed positive of H^(+)/K^(+)-ATPase,and 10 cases[33.33%(10/30)]were negative.Conclusion HGMUE is more common in male patients,and may be combined with GERD.Among them,patients with combined GERD are more likely to develop laryngopharyngeal reflux.The heterotopic gastric mucosas lesions are orange-red round,oval or elongated island-like under gastroscopy,and most of them are flat,single and median-or large-sized.Histological types are mostly fundic glands,and H^(+)/K^(+)-ATPase positive is more common.It is speculated that acid secretion may be an important factor leading to throat symptoms.