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首页> 外文期刊>Modern Pathology >The Location and Frequency of Intestinal Metaplasia at the Esophagogastric Junction in 223 Consecutive Autopsies: Implications for Patient Treatment and Preventive Strategies in Barrett's Esophagus
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The Location and Frequency of Intestinal Metaplasia at the Esophagogastric Junction in 223 Consecutive Autopsies: Implications for Patient Treatment and Preventive Strategies in Barrett's Esophagus

机译：223例连续尸检中食管胃交界处肠上皮化生的位置和频率：对巴雷特食管患者治疗和预防策略的影响

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The frequency of intestinal metaplasia at the esophagogastric junction is as high as 36% in endoscopy studies; the majority of cases (approximately 67%) occur in short segments of esophageal columnar mucosa. The validity of these studies has been questioned, however, because of heterogenous underlying diseases prompting endoscopy. To determine the frequency and origin of intestinal metaplasia at the esophagogastric junction, we histologically evaluated the entire esophagogastric junction for the presence of intestinal metaplasia using Alcian blue/periodic acid-Schiff mucin stains in 223 consecutive autopsies. Precise localization of the Z line in relation to the esophagogastric junction and tongues of esophageal columnar-appearing mucosa were noted in each case. Mean patient age was 47 years; 69% of patients were male, and 63% were white. Twenty five of 223 cases (11%) had intestinal metaplasia at the esophagogastric junction. Only 2 of 25 cases (8%) had intestinal metaplasia in the esophagus; the remaining 23 cases (92%) had intestinal metaplasia in the gastric cardia. Male gender, advanced age, white ethnic origin, and short tongues of esophageal columnar mucosa were not associated with gastric cardia intestinal metaplasia. An association of distal gastric intestinal metaplasia (P P Helicobacter pylori infection in this process. The frequency of intestinal metaplasia at the esophagogastric junction in an unselected autopsy population is low (11%) even after exhaustive histologic evaluation using Alcian blue mucin stains. Furthermore, intestinal metaplasia is confined to the gastric cardia in more than 90% of cases with no association to male gender, white ethnic origin, advanced age, or the presence of short segments of esophageal columnar-appearing mucosa at endoscopy. These results demonstrate that caution is warranted when applying the findings of endoscopy studies to the development of preventive and screening strategies aimed at identifying Barrett's esophagus in an asymptomatic general population.
机译：在内窥镜检查中，食管胃交界处肠上皮化生的频率高达36％。大多数病例（约67％）发生在食管柱状粘膜的短段。然而，由于异质性基础疾病促使内镜检查，这些研究的有效性受到质疑。为了确定食管胃交界处肠上皮化生的频率和起源，我们在223次连续的尸检中使用Alcian blue /高碘酸-席夫（Schiff）粘蛋白染色组织学评估了整个食管胃交界处肠上皮化生的存在。在每种情况下，都注意到Z线相对于食管胃交界处和食管出现柱状粘膜的舌头的精确定位。平均患者年龄为47岁; 69％的患者为男性，而63％的患者为白人。 223例中有25例（11％）在食管胃交界处出现肠上皮化生。 25例中只有2例（8％）出现食道肠上皮化生;其余23例（92％）患有card门癌。男性，高龄，白人族裔和食管柱状粘膜短舌与胃card门肠上皮化生无关。在此过程中，存在远端胃部肠上皮化生（PP幽门螺杆菌感染）的关联。即使使用Alcian蓝粘蛋白染色进行详尽的组织学评估，未选择的尸检人群中食管胃交界处肠上皮化生的频率也很低（11％）。在90％以上的病例中，肠上皮化生局限于胃card门，与男性，白人，高龄或内镜下食管柱状表皮粘膜短段的存在无关。当将内窥镜检查研究的结果应用于旨在识别无症状普通人群中的Barrett食道的预防和筛查策略的开发时，有必要进行上述检查。

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