Currently available data indicate a clear and probably causal relationship between long-lasting gastroesophageal reflux disease, the development of long segments with specialized intestinal metaplasia in the distal esophagus and subsequent progression to adenocarcinoma. To a lesser degree, this also appears to be the case for short segments of specialized intestinal metaplasia in the distal esophagus. In contrast, epidemiological data and classic parameters for the diagnosis of gastroesophageal reflux disease do not currently support a causal role of gastroesophageal reflux in the pathogenesis of specialized intestinal metaplasia at the gastric cardia. Despite its high prevalence and malignant potential, many questions about the prevention and management of intestinal metaplasia in the distal esophagus remain unsolved. In patients with chronic gastroesophageal reflux, current modes of medical therapy do not appear to prevent the development of intestinal metaplasia, while effective anti-reflux surgery seems to have a protective effect. Formal studies with adequate follow-up are, however, still lacking. Neither acid-suppression therapy nor anti-reflux surgery, with or without mucosal ablation, can reliably prevent the malignant degeneration of established intestinal metaplasia of the esophagus. Close endoscopic surveillance with extensive biopsies, therefore, remains mandatory in such patients, irrespective of the treatment modality.

译文

目前可用的数据表明,长期持续的胃食管反流病,远端食管中长节段的特殊肠上皮化生的发展以及随后发展为腺癌之间存在明确的因果关系。在较小的程度上,远端食道中特异肠化生的短节段似乎也是这种情况。相比之下,用于诊断胃食管反流疾病的流行病学数据和经典参数目前不支持胃食管反流在胃card门特殊肠化生的发病机理中的因果作用。尽管其高患病率和恶性潜能,但有关远端食管肠化生的预防和管理的许多问题仍未解决。在慢性胃食管反流患者中,目前的药物治疗模式似乎无法阻止肠上皮化生的发展,而有效的抗反流手术似乎具有保护作用。然而,仍然缺乏足够随访的正式研究。无论有无粘膜消融,抑酸疗法还是抗反流手术都不能可靠地预防已建立的食管肠化生的恶性变性。因此,对于此类患者,无论治疗方式如何,都必须进行密切的内窥镜检查和广泛的活检。

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