Research status of Barrett esophagus and treatment progress of integrated traditional Chinese and Western medicine
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摘要: Barrett食管(Barrett esophagus，BE)为胃食管反流病的重要并发症之一，是内镜下食管鳞状上皮与胃柱状上皮的交界线相对于胃食管结合部上移≥1 cm，并组织学证实食管下段的正常复层鳞状上皮被化生的柱状上皮所取代的病理现象。BE是食管腺癌目前唯一已知的癌前病变，其中伴肠上皮化生者发生食管腺癌的风险更高。随着胃食管反流病的增加，我国BE和食管腺癌的发病率也在增加，早期发现和有效管理BE，对预防和减少食管腺癌的发病有重要意义。但全球在BE的定义、诊断、治疗等方面仍存在一定争议，由于没有公认的治疗方法，BE属于难治性胃食管反流病范畴。近年来，随着内镜诊疗技术及中医药治疗BE研究水平的不断进步，BE的治疗及预防已不是遥不可及。本文就BE的研究现状及中西医结合治疗进展作一述评，以期为临床提供更明确的诊治思路。Abstract: Barrett esophagus(BE) is one of the significant complications of gastroesophageal reflux disease(GERD), characterized by the upward shift of the squamocolumnar junction by at least 1 cm above the gastroesophageal junction and histological confirmation of the replacement of the normal stratified squamous epithelium in the lower esophagus with metaplastic columnar epithelium. BE is currently the only known precancerous lesion of esophageal adenocarcinoma(EAC), and those with intestinal metaplasia have a higher risk of developing EAC. With the increase in GERD, the incidence of BE and EAC in China is also on the rise. Early detection and effective management of BE are of great significance for the prevention and reduction of EAC. However, there are still some controversies globally regarding the definition, diagnosis, and treatment of BE. Due to the lack of a recognized treatment method, BE is classified as a refractory form of GERD. In recent years, with the continuous advancement of endoscopic diagnosis and treatment techniques and the research level of traditional Chinese medicine in the treatment of BE, the treatment and prevention of BE are no longer out of reach. This article reviews the current research status of BE and the progress in integrated traditional Chinese and Western medicine treatment, aiming to provide a clearer diagnosis and treatment approach for clinical practice.
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表 1 2005—2024年各国指南BE诊断异同及演变
指南 时间 SCJ上移的长度标准/cm 组织学标准 BSG 2005年前2014年 ≥3≥1 柱状上皮柱状上皮 ACG 2016年2022年 ≥1≥1 IMIM ASGE 2012年2019年 未定义未定义 IMIM ESGE 2017年2023年 ≥1≥1 IMIM AGA 2011年 任意长度 IM 澳大利亚 2015年 任意长度 IM 中国 2017年 ≥1 柱状上皮 注：BSG：英国胃肠病学会；ACG：美国胃肠病学院；ASGE：美国消化内镜学会；ESGE：欧洲胃肠内镜学会；AGA：美国胃肠病学会。 
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表 2 BE的辨证论治及治疗
证型 治法 方药 肝胃郁热证 疏肝泄热，和胃降逆 柴胡疏肝散合左金丸加减 胆火上逆证 清化胆热，降气和胃 小柴胡汤合温胆汤加减 气郁痰阻证 行气开郁，降逆化痰 半夏厚朴汤加减 胸阳不振证 通阳宣痹，降气化痰 枳实薤白桂枝汤合小陷胸汤加减 中虚气逆证 益气健脾，和胃降逆 旋覆代赭汤合六君子汤加减 脾虚湿热证 清化湿热，健脾和胃 黄连汤加减 胃阴不足证 滋养胃阴，和胃降逆 益胃汤加减
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[1] Mohy-Ud-Din N, Krill TS, Shah AR, et al. Barrett's esophagus: what do we need to know?[J]. Dis Mon, 2020, 66(1): 100850. doi: 10.1016/j.disamonth.2019.02.003
[2] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[3] Holmberg D, Santoni G, von Euler-Chelpin M, et al. Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries: population based cohort study[J]. BMJ, 2023, 382: e076017.
[4] Peters Y, Al-Kaabi A, Shaheen NJ, et al. Barrett oesophagus[J]. Nat Rev Dis Primers, 2019, 5(1): 35. doi: 10.1038/s41572-019-0086-z
[5] Wang RH. From reflux esophagitis to Barrett's esophagus and esophageal adenocarcinoma[J]. World J Gastroenterol, 2015, 21(17): 5210-5219. doi: 10.3748/wjg.v21.i17.5210
[6] Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study[J]. J Natl Cancer Inst, 2011, 103(13): 1049-1057. doi: 10.1093/jnci/djr203
[7] Oh DS, Demeester SR. Pathophysiology and treatment of barrett's esophagus[J]. World J Gastroenterol, 2010, 16(30): 3762-3772. doi: 10.3748/wjg.v16.i30.3762
[8] Fock KM, Talley N, Goh KL, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus[J]. Gut, 2016, 65(9): 1402-1415. doi: 10.1136/gutjnl-2016-311715
[9] 王启宏. 可变暴露因素与Barrett's食管的因果关联[D]. 沈阳: 中国医科大学, 2023.
[10] 李鹏, 王拥军, 陈光勇, 等. 中国巴雷特食管及其早期腺癌筛查与诊治共识(2017万宁)[J]. 中国实用内科杂志, 2017, 37(9): 798-809.
[11] Playford RJ. New British Society of Gastroenterology(BSG)guidelines for the diagnosis and management of Barrett's oesophagus[J]. Gut, 2006, 55(4): 442. doi: 10.1136/gut.2005.083600
[12] Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus[J]. Gut, 2014, 63(1): 7-42. doi: 10.1136/gutjnl-2013-305372
[13] Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of barrett's esophagus[J]. Am J Gastroenterol, 2016, 111(1): 30-50, quiz 51. doi: 10.1038/ajg.2015.322
[14] Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of barrett's esophagus: an updated ACG guideline[J]. Am J Gastroenterol, 2022, 117(4): 559-587. doi: 10.14309/ajg.0000000000001680
[15] Evans JA, Early DS, Fukami N, et al. The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus[J]. Gastrointest Endosc, 2012, 76(6): 1087-1094. doi: 10.1016/j.gie.2012.08.004
[16] ASGE STANDARDS OF PRACTICE COMMITTEE, Qumseya B, Sultan S, et al. ASGE guideline on screening and surveillance of Barrett's esophagus[J]. Gastrointest Endosc, 2019, 90(3): 335-359. e2. doi: 10.1016/j.gie.2019.05.012
[17] Weusten B, Bisschops R, Coron E, et al. Endoscopic management of barrett's esophagus: European society of gastrointestinal endoscopy(ESGE)position statement[J]. Endoscopy, 2017, 49(2): 191-198. doi: 10.1055/s-0042-122140
[18] Weusten BLAM, Bisschops R, Dinis-Ribeiro M, et al. Diagnosis and management of barrett esophagus: European society of gastrointestinal endoscopy(ESGE)guideline[J]. Endoscopy, 2023, 55(12): 1124-1146. doi: 10.1055/a-2176-2440
[19] Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association medical position statement on the management of Barrett's esophagus[J]. Gastroenterology, 2011, 140(3): 1084-1091. doi: 10.1053/j.gastro.2011.01.030
[20] Lee YC, Cook MB, Bhatia S, et al. Interobserver reliability in the endoscopic diagnosis and grading of Barrett's esophagus: an Asian multinational study[J]. Endoscopy, 2010, 42(9): 699-704. doi: 10.1055/s-0030-1255629
[21] Naini BV, Chak A, Ali MA, et al. Barrett's oesophagus diagnostic criteria: endoscopy and histology[J]. Best Pract Res Clin Gastroenterol, 2015, 29(1): 77-96. doi: 10.1016/j.bpg.2014.11.004
[22] Aida J, Vieth M, Ell C, et al. Palisade vessels as a new histologic marker of esophageal origin in ER specimens from columnar-lined esophagus[J]. Am J Surg Pathol, 2011, 35(8): 1140-1145. doi: 10.1097/PAS.0b013e3182206c0e
[23] Oda M, Kalloo A, Mizukami K, et al. Endoscopy and barrett's esophagus: current perspectives in the US and Japan[J]. Intern Med, 2021, 60(3): 327-335. doi: 10.2169/internalmedicine.4400-19
[24] Redston M, Noffsinger A, Kim A, et al. Abnormal TP53 predicts risk of progression in patients with barrett's esophagus regardless of a diagnosis of dysplasia[J]. Gastroenterology, 2022, 162(2): 468-481. doi: 10.1053/j.gastro.2021.10.038
[25] Paterson AL, Gehrung M, Fitzgerald RC, et al. Role of TFF3 as an adjunct in the diagnosis of Barrett's esophagus using a minimally invasive esophageal sampling device-The Cytosponge(TM)[J]. Diagn Cytopathol, 2020, 48(3): 253-264. doi: 10.1002/dc.24354
[26] Fitzgerald RC, di Pietro M, O'Donovan M, et al. Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial[J]. Lancet, 2020, 396(10247): 333-344. doi: 10.1016/S0140-6736(20)31099-0
[27] Wang PZ, Meng QQ, Wang W, et al. Icariin inhibits the inflammation through down-regulating NF-κB/HIF-2α signal pathways in chondrocytes[J]. Biosci Rep, 2020, 40(11): BSR20203107. doi: 10.1042/BSR20203107
[28] Brown CS, Lapin B, Wang C, et al. Reflux control is important in the management of barrett's esophagus: results from a retrospective 1, 830 patient cohort[J]. Surg Endosc, 2015, 29(12): 3528-3534. doi: 10.1007/s00464-015-4103-3
[29] Mehta RS, Nguyen LH, Ma WJ, et al. Association of diet and lifestyle with the risk of gastroesophageal reflux disease symptoms in US women[J]. JAMA Intern Med, 2021, 181(4): 552-554. doi: 10.1001/jamainternmed.2020.7238
[30] Tosetti C, Savarino E, Benedetto E, et al. Elimination of dietary triggers is successful in treating symptoms of gastroesophageal reflux disease[J]. Dig Dis Sci, 2021, 66(5): 1565-1571. doi: 10.1007/s10620-020-06414-z
[31] Cooper BT, Chapman W, Neumann CS, et al. Continuous treatment of Barrett's oesophagus patients with proton pump inhibitors up to 13 years: observations on regression and cancer incidence[J]. Aliment Pharmacol Ther, 2006, 23(6): 727-733. doi: 10.1111/j.1365-2036.2006.02825.x
[32] Alkhayyat M, Kumar P, Sanaka KO, et al. Chemoprevention in Barrett's esophagus and esophageal adenocarcinoma[J]. Therap Adv Gastroenterol, 2021, 14: 17562848211033730. doi: 10.1177/17562848211033730
[33] Singh S, Garg SK, Singh PP, et al. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis[J]. Gut, 2014, 63(8): 1229-1237. doi: 10.1136/gutjnl-2013-305997
[34] Zhang S, Zhang XQ, Ding XW, et al. Cyclooxygenase inhibitors use is associated with reduced risk of esophageal adenocarcinoma in patients with Barrett's esophagus: a meta-analysis[J]. Br J Cancer, 2014, 110(9): 2378-2388. doi: 10.1038/bjc.2014.127
[35] Jankowski JAZ, de Caestecker J, Love SB, et al. Esomeprazole and aspirin in barrett's oesophagus(AspECT): a randomised factorial trial[J]. Lancet, 2018, 392(10145): 400-408. doi: 10.1016/S0140-6736(18)31388-6
[36] Freedberg DE, Kim LS, Yang YX. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American gastroenterological association[J]. Gastroenterology, 2017, 152(4): 706-715. doi: 10.1053/j.gastro.2017.01.031
[37] Othman MO, Wallace MB. Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)in 2011, a Western perspective[J]. Clin Res Hepatol Gastroenterol, 2011, 35(4): 288-294. doi: 10.1016/j.clinre.2011.02.006
[38] Vantanasiri K, Joseph A, Sachdeva K, et al. Rates of recurrent intestinal Metaplasia and dysplasia after successful endoscopic therapy of barrett's neoplasia by endoscopic mucosal resection vs endoscopic submucosal dissection and ablation: a large North American multicenter cohort[J]. Am J Gastroenterol, 2024, 119(9): 1831-1840. doi: 10.14309/ajg.0000000000002798
[39] Michopoulos S. Critical appraisal of guidelines for screening and surveillance of Barrett's esophagus[J]. Ann Transl Med, 2018, 6(13): 259. doi: 10.21037/atm.2018.05.09
[40] Qumseya BJ, Wani S, Gendy S, et al. Disease progression in barrett's low-grade dysplasia with radiofrequency ablation compared with surveillance: systematic review and meta-analysis[J]. Am J Gastroenterol, 2017, 112(6): 849-865. doi: 10.1038/ajg.2017.70
[41] Tanțǎu M, Laszlo M, Tanțǎu A. Barrett's esophagus-state of the art[J]. Chirurgia(Bucur), 2018, 113(1): 46-60.
[42] Pacifico RJ, Wang KK, Wongkeesong LM, et al. Combined endoscopic mucosal resection and photodynamic therapy versus esophagectomy for management of early adenocarcinoma in Barrett's esophagus[J]. Clin Gastroenterol Hepatol, 2003, 1(4): 252-257. doi: 10.1016/S1542-3565(03)00129-0
[43] Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review[J]. Ann Surg, 2007, 246(1): 11-21. doi: 10.1097/01.sla.0000261459.10565.e9
[44] 中华中医药学会脾胃病分会. 胃食管反流病中医诊疗专家共识(2023)[J]. 中医杂志, 2023, 64(18): 1935-1944.
[45] 王晓, 王晓素, 周秉舵, 等. 柴胡疏肝散合旋覆代赭汤治疗肝胃不和型Barrett食管的临床观察[J]. 中国实验方剂学杂志, 2024, 30(24): 10-17.
[46] 杨静, 毛宇湘, 许玉娜, 等. 和胃1号方联合埃索美拉唑治疗Barrett食管的疗效及对IL-2、TNF-α和ET水平影响[J]. 中华中医药学刊, 2021, 39(4): 188-191.
[47] 王俊, 孙懿, 黄雅慧, 等. 清肝健脾方治疗Barrett食管临床疗效及其对Cdx2和p38MAPK的表达影响[J]. 中华中医药学刊, 2016, 34(2): 496-498.
[48] 刘刚, 康玉杰. 苓桂半夏汤配合奥美拉唑、铝碳酸镁治疗Barrett食管的效果及对Cox-2和Ki-67表达的影响[J]. 现代中西医结合杂志, 2018, 27(29): 3236-3239.
[49] 胡蓆宝, 田晶晶, 梁若冰, 等. 加味启膈散抑制细胞增殖治疗Barrett食管作用机制研究[J]. 中国中西医结合外科杂志, 2020, 26(3): 416-422.
[50] Singh S, Manickam P, Amin AV, et al. Incidence of esophageal adenocarcinoma in Barrett's esophagus with low-grade dysplasia: a systematic review and meta-analysis[J]. Gastrointest Endosc, 2014, 79(6): 897-909. http://www.xueshufan.com/publication/2137173028
[51] Rastogi A, Puli S, El-Serag HB, et al. Incidence of esophageal adenocarcinoma in patients with Barrett's esophagus and high-grade dysplasia: a meta-analysis[J]. Gastrointest Endosc, 2008, 67(3): 394-398. http://pubmed.ncbi.nlm.nih.gov/18550563/
[52] Jovani M, Cao Y, Feskanich D, et al. Aspirin use is associated with lower risk of barrett's esophagus in women[J]. Gastroenterology, 2017, 152(5): S105.
[53] Omer ZB, Ananthakrishnan AN, Nattinger KJ, et al. Aspirin protects against Barrett's esophagus in a multivariate logistic regression analysis[J]. Clin Gastroenterol Hepatol, 2012, 10(7): 722-727. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435144/pdf/nihms378673.pdf
[54] Thrift AP, Anderson LA, Murray LJ, et al. Nonsteroidal anti-inflammatory drug use is not associated with reduced risk of barrett's esophagus[J]. Am J Gastroenterol, 2016, 111(11): 1528-1535.
[55] 杨炳银, 宗君, 仓艳红, 等. 二甲双胍治疗前后Barrett食管黏膜组织p53和TNF-α表达改变及意义[J]. 中华肿瘤防治杂志, 2019, 26(2): 107-112.
[56] 杨莉, 唐艳萍. 活血通降方对糜烂性食管炎瘀血阻络型食管黏膜、运动功能及LES压力的影响[J]. 辽宁中医杂志, 2020, 47(7): 77-80, 221.
[57] 尹红, 唐艳萍, 杨磊, 等. 活血通降方对反流性食管炎大鼠肠道菌群及Caspase-3/GSDME通路的影响[J]. 中国中西医结合消化杂志, 2022, 30(10): 701-707, 712. doi: 10.3969/j.issn.1671-038X.2022.10.04
[58] 李培彩, 唐艳萍, 尹红, 等. 活血通降方对反流性食管炎大鼠食管内脏高敏感及LPS/TLR4/MC通路的影响[J]. 中国中西医结合消化杂志, 2023, 31(7): 538-544, 551. doi: 10.3969/j.issn.1671-038X.2023.07.11
[59] 刘琰, 唐艳萍, 刘磊, 等. 活血通降方对反流性食管炎模型大鼠食管动力、血清炎症因子及食管下括约肌SCF/c-kit信号通路的影响[J]. 中医杂志, 2022, 63(3): 269-275.
[60] Liu Y, Tang YP, Li PC, et al. Huoxue Tongjiang decoction-resisted reflux esophagitis by activation stem cell factor/c-kit/interstitial cell of Cajal pathway and regulating the T-helper 17/regulatory T-cells balance in rats[J]. Tradit Med Res, 2024, 9(12): 68. http://d.wanfangdata.com.cn/periodical/ctyxyj-e202412001
[61] 吕迎春, 赵炜, 蔡翠珠, 等. 益气健脾清肝和胃方对脾胃虚弱型胃食管反流患者的临床疗效[J]. 中成药, 2024, 46(8): 2830-2833.
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