盘点:2018年2月Gastroenterology研究精选——食道疾病特刊

2018-02-05 zhangfan MedSci原创

2018年2月Gastroenterology研究精选——食道疾病特刊



【1】胃食管反流病的流行病学


胃食管反流病(GERD)是美国最常见的胃肠道疾病,发病率很高,但相关死亡率很低。自1999年以来,GERD的发病率呈上升趋势。GERD的危险因素包括高龄、男性、白人种族、腹部肥胖和吸烟。大部分患者存在胃灼热和反流敏感的症状。GERD患者出现吞咽困难被认为是一种恶化症状,需进行进一步的评估。临床实践中GERD的症状与嗜酸细胞性食管炎、功能性消化不良和胃轻瘫存在重叠,给病人的治疗带来了挑战。

【2】胃食管反流病治疗进展


对于无恶化症状的胃食管反流病(GERD)患者,治疗通常从经验性的质子泵抑制剂(PPI)和生活方式改善开始。提高PPI治疗的依从性、治疗时间或剂量加倍可以减少疾病症状。对于持续性症状患者可通过内镜检查和食管生理检查进行深入评估,以更好地确定疾病表型并优化治疗方案。大部分患者可以从腹腔镜下胃底折叠术、磁性括约肌扩张术和内镜治疗中受益。对于GERD伴其他功能性疾病患者,神经调节剂(是抗抑郁药)或心理干预(心理治疗、催眠治疗、认知和行为治疗)也可以获得较好的效果。正处于研究阶段的GERD治疗方法包括钾竞争性酸阻滞剂、反流还原剂、胆汁酸结合剂、食管胃连接处惰性物质注射和食管括约肌电刺激等。

【3】嗜酸粒细胞性食管炎的诊断和治疗


嗜酸粒细胞性食管炎(EoE)是一种新型疾病,是II型辅助T细胞与食管粘膜食物抗原作用导致的特定免疫性疾病。EoE尚无确切的疾病标准,其诊断往往依赖一系列人口学、临床、内镜和组织学特征。儿童EoE患者往往存在炎症和内镜病变,而青少年和成人患者则有纤维化和严重食管狭窄特征。临床和内窥镜评分系统有助于EoE诊断标准化。现阶段的EoE研究中,对于治疗最佳终点的选择存在争议,最常用的治疗终点是活检嗜酸性粒细胞减少,但症状和内镜特征改变正成为重要的治疗终点。

【4】食管腺癌流行病学研究


近年来,许多西方国家食管腺癌(EAC)的发病率有所增加,男性疾病风险高于女性。EAC风险因素主要包括胃食管反流病,巴雷特食管,肥胖和吸烟,除戒烟外,其他风险因素干预对降低EAC风险的效果仍无明确结论。饮酒与EAC风险无关,但其他因素,如体力活动、营养和药物使用对EAC的影响仍需进一步研究。基因变异与EAC风险有关,但影响很低。各个EAC亚型与风险因素之间的关系尚不明确。现阶段EAC患者预后略有改善,但仍然较差,高危人群进行筛查和监测是降低EAC发病,减少死亡率的重要方法。

【5】早期食管癌诊断及治疗方案


内镜对食管癌的早期诊断和治疗十分重要,但由于早期症状特征不显著,大部分患者内镜检查并不及时。大部分患者出现吞咽困难后才进行检查,而吞咽困难往往是疾病晚期的显著症状,晚期患者的5年生存率不足15%。大规模的内镜筛查并不符合成本效益,成像和细胞分析技术对于早期食管癌的筛查效果尚不清楚。过去10年间,内镜诊断和异型增生治疗取得了显著进步,随机对照试验证实切除和消融技术可显著改善早期食管癌患者预后。

【6】食管腺癌或鳞癌的治疗进展


食管癌的特点是早期和频繁转移,手术是疾病早期的重要治疗手段,而局部晚期患者在围手术期需进行化疗或放射治疗。未经手术的鳞状细胞癌患者可以接受化学或放射治疗,这取决于治疗反应和病人对后续手术的耐受性。氟嘧啶和铂类药物是一线化疗手段,紫杉烷和伊立替康为二线治疗方法。Erb-B2受体酪氨酸激酶2 (ERBB2或HER2)或血管内皮生长因子抑制剂,包括trastuzumab, ramucirumab以及 apatinib等靶向治疗可极大的改善治疗响应和生存期。食管腺癌与肿瘤蛋白p53突变,酪氨酸激酶相关受体激活突变、血管内皮生长因子和细胞周期通路相关,而食管鳞状细胞癌突变特征则更为复杂。食道癌与肿瘤免疫反应逃逸相关,但免疫检查点抑制剂对食道肿瘤的效果仍需进一步的研究。

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    2018-08-28 许安
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    2018-02-15 天涯183

    非常好的文章.学习了

    0

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