慢性咽炎?原来是食管胃黏膜异位症在作怪!

2018-08-18 常玉英 胃肠病

患者王某,男性,43岁。咽部异物感、咽部不适、疼痛多年,伴有口水多,有时咳嗽。加重1个月来诊。既往曾在耳鼻喉科和呼吸科多次就诊,诊断为慢性咽炎、气管炎、扁桃腺炎、咽后壁淋巴滤泡增生、鼻窦炎等。经过相应治疗,效果欠佳,症状反反复复,患者非常苦恼。

病例:

患者王某,男性,43岁。咽部异物感、咽部不适、疼痛多年,伴有口水多,有时咳嗽。加重1个月来诊。既往曾在耳鼻喉科和呼吸科多次就诊,诊断为慢性咽炎、气管炎、扁桃腺炎、咽后壁淋巴滤泡增生、鼻窦炎等。经过相应治疗,效果欠佳,症状反反复复,患者非常苦恼。

本次就诊,进行了食管镜-镜检查,发现食管入口处,距离门齿19cm~16cm处可见椭圆形橘红色黏膜区3处,分别为0.5cmX0.6cm、3.0cmX1.5cm、1.2cmX1.0cm,沿着食管纵轴分布,对吻分布。病理确诊食管黏膜异位。后给予患者相应治疗,患者症状消失,心情也豁然开朗起来了。

一、什么是食管胃黏膜异位症?

食管胃黏膜异位症(heterotopicgastricmucosainesophagus)是一种少见的先天性胚胎残余病变,可发生于食管的任何部位,以食管上1/3段多见,近环咽肌水平。

其病因尚未完全明确,大多认为与先天发育异常有关。在胚芽时,食管表面被覆柱状上皮由复层鳞状上皮替换,如果此替换过程不完全可造成胚胎性胃黏膜残留于食管,而发生食管胃黏膜异位。

本病患者常同时合并有胃酸过度分泌的疾病,且Barrett食管的患病率明显增高,因此,食管胃黏膜异位可能是一种双重病因的疾病在潜在的先天胚胎发育异常的基础上由合并后天酸反流刺激等因素所造成。

近年来,随着电子胃镜广泛普及及检查和治疗技术的提高,发现本病病例有所增加,国内外报道内镜检出率4.9%~10%。

二、食管胃黏膜异位症的诊断

诊断要点:

1.无症状或吞咽不适;

2.内镜检查示食管上段橘红色黏膜;

3.病理活检示胃底腺体含泌酸细胞。





食管胃黏膜异位症的患者临床表现多无特异性,大多数仅在镜检时偶然发现,但有时亦可出现酸相关症状,如胸骨后不适和吞咽疼痛等不适。部分患者可以出现慢性咽喉炎、口水多等症状,内镜检查是诊断本病的主要手段,但常因位置较高容易漏诊。

提高检出率的关键在于提高内镜医师对本病的认识。因病变位于食管颈段,普通胃镜观察有时不大清楚,容易出现漏诊,采用NBI模式的胃镜则可明显提高发现率。

典型的病变是在食管上段出现边界清楚的椭圆形或圆形橘红色黏膜,与周围食管黏膜分界清楚,少数病例可出现息肉型或隆起型病变。活检病理检查可发现胃底腺体。部分尚可见幽门腺体。



食管异位性胃黏膜癌变极为罕见,但容易合并幽门螺杆菌感染

本病易与Barrett食管混淆,后者有SCJ(Z线)上移和肠化可资鉴别。

临床如果遇到不明原因的咽痛、咳嗽、咽部异物感、口臭、烧心、反酸等症状的患者,迁延不愈者,要想到该病的可能,可能会获得较好的帮助。

三、食管胃黏膜异位症的治疗

治疗要点:

1.无症状者无需特殊处理;

2.合并反流症状进行抑酸治疗;

3.症状频繁行内镜下治疗。

食管胃黏膜异位患者如无临床症状,可暂不作特殊治疗,但由于异位胃黏膜具有泌酸功能,可引起食管溃疡、出血或并发胃食管反流病,可用PPI制剂进行抑酸治疗。

大多数患者采用常规剂量即可缓解症状,抑酸治疗无效、症状频繁、患者心理负担重或可疑癌变可行内镜下治疗。包括内镜下激光、氩气刀及高频电灼等,必要时可行内镜黏膜下剥离切除。

食管胃黏膜异位伴狭窄、穿孔等严重并发症可考虑外科手术。

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    2021-08-22 云舒

    好👌

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    2019-01-30 baoya
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    2018-08-20 zhouqu_8
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    2018-08-20 snowpeakxu

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