Clinical features of Barrett's esophagus, Barrett esophagus in men with multiple male and female incidence ratio (3:1) _ (4:1), more common in clinical practice, the elderly sick. The disease mainly as follows: gastric esophageal reflux caused by a retrosternal burning sensation, chest pain and acid reflux, some patients suffered from anemia or upper gastrointestinal bleeding.
Barrett esophagus can be serious complications, benign complications include reflux esophagitis, esophageal stricture, esophageal ulcer, esophageal perforation, esophageal bleeding and aspiration pneumonia, malignant complications of esophageal cancer .
Cameron Barrett's esophagus reported incidence of 22.6/10 million, and an autopsy found that the incidence rate of 376/10 million, a difference of almost 20 times, can be speculated that the actual incidence may be higher. Generally believed, Barrett's esophagus and race-related morbidity and rare in the non-white groups, but recent studies have shown that the disease is prevalent non-Caucasian countries. From Arab countries and China's Taiwan Province, studies have shown that disease incidence in these areas rise.
Clinical characteristics of Barrett esophagus, and Taiwan Province to the information in the region of 6% of patients with heartburn symptoms to Barrett esophagus, Nabel reported that the U.S. is 7%, both very close. The disease is also related to diet, population aging and obesity. Barrett esophagus is a precancerous lesion of esophageal adenocarcinoma, the incidence of esophageal adenocarcinoma is closely related to esophageal adenocarcinoma in 50% of Barrett esophagus. Is a high incidence of esophageal cancer, including esophageal adenocarcinoma, 5%, and therefore the study of early awareness of the clinical features of Barrett's esophagus on the prevention and treatment of adenocarcinoma of the esophagus is of great clinical significance. In esophageal cancer 10% _40% of patients associated with Barrett esophagus, 64% of patients with esophageal adenocarcinoma associated with Barrett esophagus. Barrett esophagus in patients with esophageal cancer risk 40 times higher than the normal population. Special type of Barrett epithelium prone to cancer, cancer was 2.5% _41%, an average of 10%. Cancer and epithelial metaplasia itself is an unstable state, such as cell proliferation kinetics of epithelial cell cycle faster performance; Barrett's epithelium and tumor tissue the same enzymatic characteristics, such as ornithine decarboxylase activity at a high level; epithelial cells of mucous tissue change; ultrastructure of nuclear structure in the epithelial atypia and other relevant changes. Ki-67 and PCNA detection of Barrett esophagus epithelial cells showed increased activity, flow cytometry up to 1 / 3 of the cells into the cell cycle G1 phase, S phase fraction is relatively increased, and the proportion of aneuploid 80% and multiple sites in a chromosome loss of heterozygosity, tumor suppressor gene p53, APC, MCC and oncogene EGFP, Er-B-2 and TGF, FGF and other genes in the Barrett esophagus suggest abnormal expression by autocrine mechanism to promote cell cycle progression and cancer. If the malignant transformation of Barrett esophagus to confirm the molecular mechanisms will contribute to the detection of early esophageal cancer and esophageal cancer prevention and treatment.
Columnar metaplasia of Barrett's esophagus, including endoscopic esophageal squamous epithelium is easily distinguished, which for the early diagnosis of patients with gastroesophageal reflux provided. Meanwhile, further clarify the occurrence and risk factors of Barrett esophagus help to improve diagnosis. As the evolution from metaplasia to cancer is a gradual process, so that effective preventive measures to prevent and reduce detection Barrett esophagus cancer.
Clinical features of Barrett's esophagus, such as on the 46,161 cases in recent years, Tao Deming esophageal epithelial hyperplasia in normal and cancerous time, cancer rates in the study showed severe epithelial hyperplasia of esophageal cancer on average for 3 years and 7 months, mild hyperplasia of the average cancer for 5 years and 4 months, the average normal esophageal epithelial cancer was 8 years 10 months; severe hyperplasia of cancer was 88.9%, mild hyperplasia of cancer was 5.8%, the normal esophageal epithelium by cancer was 1.4% . Confirmed during the development of esophageal cancer in normal esophageal epithelial cells from mild hyperplasia severe hyperplasia of esophageal cancer process. Severe hyperplasia of the probability of occurrence of cancer 69 times higher than the normal population, so severe esophageal epithelial hyperplasia is considered a precancerous lesion of esophageal cancer. Severe esophageal epithelial hyperplasia and blocking is to reduce the incidence of esophageal cancer is one of effective measures. Shen Qiong granted such as the use sticky crude riboflavin, Hara and other patients were blocked for precancerous study. 1988–1992 years, in order to carry out crude riboflavin blocking studies have shown that long-term use can make crude riboflavin in patients with mild dysplasia 57.1% decline in cancer rates, suggesting that crude riboflavin has obvious blocking and prevention.
Some data indicate that esophageal hiatus shop, esophageal tubes, esophageal and gastric cardia twins recover from illness such as white spot disease of esophageal precancerous lesions. While each cancer reported the frequency of these diseases vary widely, but the common impression is that these lesions can lead to chronic inflammation or the formation of esophageal ulcer, chronic inflammation in the long term, based on the proliferation of esophageal epithelial cells develop from mild to severe hyperplasia , then can be cancerous. State forests in the high incidence of esophageal cancer, esophageal cytology in the clinic, about 13% of esophagitis. Endoscopic bite census taken in the organization, by the histopathological examination revealed varying degrees of esophagitis in about 80%, and confirmed esophagitis, esophageal epithelial hyperplasia and the incidence of esophageal cancer was positively correlated. Ismail so that the performance of the early days of esophagitis is inherent in the basal cell proliferation and epithelial membrane surface to stretch the nipple. This is the endoscopic biopsy and smear cells and surgical specimens of adjacent epithelial proliferative changes are consistent.
Surgical resection in early esophageal cancer specimens, increased levels of adjacent epithelial cells, especially basal cell hyperplasia, cancer is surrounded by epithelial hyperplasia. Some of the different regions and different age groups of esophageal cancer esophageal epithelial cell proliferation and the relationship between the prevalence were compared and found that forests in northern states than in the south not only the high incidence of esophageal cancer (13% in northern and southern 7%) and cell proliferation correspondingly higher prevalence (22.5% in northern and southern 18:3%), and found that cell proliferation and cancer incidence increases with age.
Patients with esophageal epithelial hyperplasia of the esophagus follow-up results also shows the relationship between epithelial hyperplasia and cancer, severe hyperplasia of the cancer incidence rate was 26.6%, while the proliferation of normal esophageal epithelium cancer incidence was 0.19%, the former is 40 times the latter.
It should be noted that, although the Barrett esophagus can easily develop into cancer, but in the clinical diagnosis of Barrett's esophagus rate of less than 1 / 6, Barrett esophagus patients with reflux symptoms and reflux disease, there is no other significant difference, but also Barrett esophagus patients with severe symptoms and less. In fact, only patients with mild reflux symptoms also may be the Barrett esophagus. In short, with reflux symptoms for a long time, especially in patients with nocturnal reflux Barrett esophagus a
nd esophageal adenocarcinoma patients at greater risk for mild reflux and reflux in patients with short-term there is a certain risk.
Obesity is an important risk of esophageal adenocarcinoma factor. Obesity can increase the severity of GERD, thus increasing the incidence of Barrett's esophagus, but also can affect the proliferation of metaplastic mucosa. In obese patients, often more than a high intra-abdominal pressure, LES (lower esophageal sphincter) relaxation and increase acid reflux; in affected mucosa, the mucous membrane easily lead to high insulin, insulin resistance and the membrane, the membrane of the rise, insulin high number of metabolites can stimulate cancer-causing substances, including excessive. In addition, the external environment in the cancer-causing agents can easily aggregate in adipose tissue. Therefore, these patients also a corresponding increase in opportunities for esophageal cancer.