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L’endobrachyœsophage : une pathologie fonctionnelle du tractus digestif supérieur

Barrett’s esophagus : a functional foregut disorder

  • Published:
Acta Endoscopica

Résumé

La présence d’un endobrachyœsophage et de ses complications chez un patient souffrant de reflux gastro-œsophagien résulte d’une association de troubles fonctionnels du tractus digestif supérieur. Malgré une moindre fréquence du pyrosis et des régurgitations acides, les patients porteurs d’un endobrachyœsophage, présentent un temps d’exposition supérieur à un pH inférieur à 2, pH inférieur à 3 et pH inférieur à 4, lors des enregistrements par pHmétrie ambulatoire de 24 heures, lorsqu’on les compare à des patients souffrant d’œsophagite. Ceci résulte d’une fréquence accrue et d’une durée prolongée des épisodes de reflux secondaires à une moindre efficacité du sphincter œsophagien inférieur, une déficience de la clairance œsophagienne et un accroissement de la sécrétion acide basale et après stimulation. L’accentuation d’un reflux duodéno-gastrique chez un patient présentant une déficience du sphincter œsophagien inférieur est responsable des épisodes de reflux alcalin observés chez certains patients porteurs d’un endobrachyœsophage. En cas d’endobrachyœsophage, le reflux alcalin semble prédisposer aux complications, sténoses et ulcérations, et paraît avoir un rôle promoteur de la dysplasie et de l’adénocarcinome. Ces observations expliquent la fréquence des échecs du traitement médical chez les patients porteurs d’un endobrachyœsophage et sont en faveur de la correction chirurgicale de l’insuffisance fonctionnelle du sphincter œsophagien inférieur.

Summary

A combination of functional foregut abnormalities are associated with the presence of Barrett’s esophagus and its complications in patients with gastroesophageal reflux disease. Despite less hearthburn and regurgitation, patients with Barrett’s esophagus have higher % time with pH<2, pH<3, and pH<4 on ambulatory 24-hour esophageal pH monitoring as compared to patients with esophagitis. This is due to an increased frequency and prolonged duration of reflux episodes secondary to a mechanically defective lower esophageal sphincter in combination with compromised esophageal clearance function and increased basal and stimulated gastric acid secretion. Excessive duodenogastric reflux in the presence of a mechanically defective lower esophageal sphincter is responsible for the increased esophageal alkaline exposure observed in some patients with Barrett’s esophagus. Alkaline reflux in patients with Barrett’s esophagus appears to predispose to the development of complications, i.e. strictures and ulcerations, and may promote dysplasia and the development of adenocarcinoma. These observations explain why medical therapy frequently fails in patients with Barrett’s esophagus and support a surgical correction of the defective lower esophageal sphincter.

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Authors and Affiliations

  1. Department of Surgery, University of Southern California School of Medicine, 1510 San Pablo Street, Suite 514, 90033-4612, Los Angeles, California, U.S.A.

    J. Stein, S. Hoeft & T. R. DeMeester M.D.

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  1. J. Stein
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  2. S. Hoeft
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  3. T. R. DeMeester M.D.
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Stein, J., Hoeft, S. & DeMeester, T.R. L’endobrachyœsophage : une pathologie fonctionnelle du tractus digestif supérieur. Acta Endosc 23, 83–91 (1993). https://doi.org/10.1007/BF02968618

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  • DOI: https://doi.org/10.1007/BF02968618

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