| 特集名 | Barrett食道 | |
|---|---|---|
| 題名 | Barrett食道の治療とサーベイランス | |
| 発刊年月 | 2007年 01月 | |
| 著者 | 天野 祐二 | 島根大学医学部附属病院光学医療診療部 |
| 著者 | 森山 修行 | 島根大学医学部附属病院医学部消化器・肝臓内科学 |
| 著者 | 木下 芳一 | 島根大学医学部附属病院医学部消化器・肝臓内科学 |
| 【 要旨 】 | Barrett食道の治療の目的は，Barrett腺癌発癌抑制に尽きる．プロトンポンプ阻害薬 (PPI) 投与は酸逆流抑制作用および細胞増殖抑制効果などにより，Barrett食道を消褪させ，発癌を抑制する可能性が考えられている．さらに，内視鏡的Barrett食道焼灼術を併用することで，さらなる効果を示す報告も多い．しかしながら，その効果を疑問視する報告も存在し，確証が得られるに至っていない．一方，NSAIDsおよびCOX-2選択的阻害薬投与によるBarrett腺癌発癌抑制効果の信憑性は高く，今後のprospective studyでの実証が待たれる． 本邦でも今後Barrett腺癌が増加すると懸念されるなか，Barrett食道の内視鏡サーベイランスが必要な時期にきていると考える．色素，拡大，Narrow Band Imaging (NBI) 内視鏡などを駆使した本邦なりの効率の高いサーベイランス法の確立が期待されている． |
|
| Theme | Barrett's Esophagus | |
|---|---|---|
| Title | Medical Management and Endoscopic Surveillance of Barrett's Esophagus | |
| Author | Yuji Amano | Division of Gastrointestinal Endoscopy, Shimane University Hospital |
| Author | Nobuyuki Moriyama | Department of Gastroenterology and Hepatology, Shimane University, School of Medicine |
| Author | Yoshikazu Kinoshita | Department of Gastroenterology and Hepatology, Shimane University, School of Medicine |
| [ Summary ] | The most important role for medical management of Barrett's esophagus is suppression of associated carcinogenesis. The efficacies of PPI and endoscopic surgery with PPI administration for Barrett's esophagus have been assessed, and some benefits have been demonstrated in Barrett's regression and / or suppression of Barrett's carcinogenesis by some investigators. However, other investigators have reported that many cases treated with endoscopic surgery and PPI administration showed a relapse and recurrence of Barrett's dysplastic lesions. Thus, there is still conflict concerning whether these treatments demonstrate good outcomes or not. Further studies are required to clearly elucidate their effect. On the other hand, administration of NSAIDs or selective COX-2 inhibitors has been proven to suppress Barrett's carcinogenesis. A prospective study with a large population is now ongoing and will undoubtedly demonstrate the efficacy of these drugs. In Japan, endoscopic Barrett's surveillance is also considered to be needed at present since the number of patients with Barrett's cancer may explosively increase as has occured in Western countries. However, patients with Barrett's esophagus in Japan show different characteristics from those in Western countries. For instance, a majority of patients have short segment type Barrett's esophagus. Therefore, establishment of a unique surveillance method is required for Japanese Barrett's esophagus in the near future. |
|