文章：

反流，巴雷特食管和腺癌：亟待解决的问题

Reflux, Barrett's oesophagus and adenocarcinoma: burning questions

原文发布日期：2003-09-01

DOI: 10.1038/nrc1166

类型: Review Article

开放获取: 否

要点：

1. Oesophageal adenocarcinoma (EA) is commonly preceded by replacement of the normal squamous epithelium by a specialized metaplastic columnar-like epithelium, termed Barrett's oesophagus (BE). Individuals with BE have at at least an order of magnitude increased risk of EA.
2. EA is increasing in incidence in Western countries and in Australia, with an approximate doubling in incidence over a ten-year period. However, potential misclassification of adenocarcinomas of the lower oesophagus and gastric cardia complicate interpretations of time trends in incidence. There is much less information concerning trends in the incidence of BE.
3. Gastro-oesophageal reflux disease (GERD) is a strong risk factor for both the development of BE and EA. Other risk factors include obesity; diets low in fruit, vegetables and fibre; and tobacco.
4. The process by which reflux constituents provoke BE and progression to EA are ill-defined. Acid exposure stimulates the formation of a columnar epithelial phenotype and modifies cell proliferation. The role of bile salts might be potentially modulated by the mildly acidic pH conditions that are stimulated by acid-suppressive medication.
5. The development and progression of BE is characterized by the acquisition of many molecular changes. These molecular changes could be used as biomarkers to refine surveillance programmes in patients with BE.
6. Evidence indicates that oxidative stress and chronic inflammation promote the development and progression of BE. This affords the opportunity for preventative intervention strategies — potentially involving dietary antioxidants and non-steroidal anti-inflammatory drugs.

要点翻译：

1. 食管腺癌（EA）通常以正常鳞状上皮被一种特殊的化生性柱状上皮（称为巴雷特食管（BE））所替代为前兆。巴雷特食管患者罹患食管腺癌的风险至少增加一个数量级。
2. 在西方国家和澳大利亚，食管腺癌的发病率正在上升，十年期间发病率约翻了一番。然而，食管下段腺癌和胃贲门癌的潜在错误分类使发病率时间趋势的解读复杂化。关于巴雷特食管发病率趋势的信息则少得多。
3. 胃食管反流病（GERD）是巴雷特食管和食管腺癌的重要风险因素。其他风险因素包括肥胖、水果蔬菜和纤维摄入量低的饮食以及吸烟。
4. 反流成分引发巴雷特食管并进展为食管腺癌的过程尚不明确。酸暴露刺激柱状上皮表型的形成并改变细胞增殖。胆汁酸盐的作用可能受到抑酸药物刺激产生的轻度酸性pH条件的潜在调节。
5. 巴雷特食管的发生和进展以获得许多分子改变为特征。这些分子变化可作为生物标志物，用于改进巴雷特食管患者的监测方案。
6. 证据表明氧化应激和慢性炎症会促进巴雷特食管的发生和进展。这为预防性干预策略提供了机会——可能涉及膳食抗氧化剂和非甾体抗炎药。

英文摘要：

The incidence of oesophageal adenocarcinoma is increasing rapidly in Western populations. Gastro-oesophageal reflux disease is a strong risk factor for both this tumour and the pre-cancerous lesion Barrett's oesophagus, but the underlying disease mechanisms remain unclear. Developing a better understanding of the aetiology and pathogenesis of Barrett's oesophagus, including the induction of DNA damage and genetic alterations, might provide opportunities for improved management of individuals with this disease. This could include a better rationale for screening and surveillance programmes, as well as targeted intervention strategies.

摘要翻译： 

食管腺癌在西方人群中的发病率正在迅速上升。胃食管反流病是该肿瘤及癌前病变巴雷特食管的强危险因素，但其潜在的疾病机制仍不清楚。更深入地了解巴雷特食管的病因和发病机制，包括DNA损伤的诱导和遗传改变，可能为改善该疾病患者的管理提供机会。这可能包括为筛查和监测项目提供更好的依据，以及制定针对性的干预策略。

原文链接：

Reflux, Barrett's oesophagus and adenocarcinoma: burning questions