小児のBarrett食道

Barrett's Esophagus in Children

要旨　小児のBarrett食道の4例を報告した．年齢分布は6歳から14歳で，すべて男児であった．逆流性食道炎の症状を認めた．X線学的には全例にバリウムの逆流を認めた．内視鏡検査ではBarrett上皮の部位はpink-redであった．ルゴール塗布では不染色性であった．組織学的に3型に分けたが，fundic type 2型，specialized type 1型，junctional type 1例であった．以上の所見は成人例の特徴と何ら異なることはなかった．成因では後天性説を支持した．われわれが日常経験する小児Barrett食道の症例では文献上からも先天性と判断できる症例は非常にまれと思われる．dysplasiaや核のatypiaを伴った症例は少なかったが，経過観察を十分に行い，発癌のリスクを念頭におくべきである．

　Four cases of Barrett's esophagus occurring in children are described. All patients, ranging from six to fourteen years old, were boys with symptoms of reflux esophagitis. Barium swallow demonstrated gastroesophageal reflux in all cases. Endoscopic examination revealed pink-red mucosal lesions which were not stained with Lugol's solution. Histopathologically, two were classified into fundic type, one specialized type, and one junctional type by Paull's classification. These characteristics were not different from those of Barrett's esophagus seen in adults. Since there were only a few cases of Barrett's esophagus in children considered to as congenital, we support the concept that Barrett's esophagus is acquired. These mucosa, although lacking dysplasia or atypia, should be followed and evaluated for possible development of carcinoma.