日本患者中通过内镜检查评估胃食管瓣阀、反流性食管炎、巴雷特上皮和萎缩性胃炎之间的关联。

Association between gastroesophageal flap valve, reflux esophagitis, Barrett's epithelium, and atrophic gastritis assessed by endoscopy in Japanese patients.

作者信息

Fujiwara Yasuhiro, Higuchi Kazuhide, Shiba Masatsugu, Watanabe Toshio, Tominaga Kazunari, Oshitani Nobuhide, Matsumoto Takayuki, Arakawa Tetsuo

机构信息

Department of Gastroenterology, Osaka City University, Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan.

出版信息

J Gastroenterol. 2003;38(6):533-9. doi: 10.1007/s00535-002-1100-9.

DOI:10.1007/s00535-002-1100-9

PMID:12825128

Abstract

BACKGROUND

Endoscopic grading of the gastroesophageal flap valve (GEFV) is a useful predictor of gastroesophageal reflux status; abnormal GEFV was associated with reflux esophagitis. Atrophic gastritis is often found in Japanese patients and is inversely related to reflux esophagitis. The aim of this study was to examine the association between GEFV, reflux esophagitis, Barrett's epithelium, and atrophic gastritis in Japanese patients by prospective endoscopic assessment.

METHODS

We enrolled 548 Japanese patients (296 men and 252 women; mean age, 57.3 years). GEFV was assessed by the classification of Hill and colleagues, reflux esophagitis was assessed by the Los Angeles classification, and the degree of atrophic gastritis was scored as: none, mild, moderate, or severe. Barrett's epithelium was recognized by the endoscopic detection of an upward shift in the columnar lining.

RESULTS

Reflux esophagitis and Barrett's epithelium were found in 42 (7.7%) and 67 (12.2%) patients, respectively. An increased prevalence of reflux esophagitis and Barrett's epithelium was correlated with an increased grade of GEFV. Abnormal GEFV (grades III and IV) was a risk for reflux esophagitis (adjusted odds ratio [OR]), 13.33 (95% confidence interval [CI], 6.08-29.25) and Barrett's epithelium (OR, 3.55 [95% CI, 2.04-6.20]), while the presence of atrophic gastritis was inversely associated with reflux esophagitis (OR, 0.15 [95% CI, 0.07-0.36]), but it was not associated with the prevalence of Barrett's epithelium (OR, 1.16 [95% CI, 0.67-2.01]). The prevalence of Barrett's epithelium and the severity of atrophic gastritis increased with age, while that of reflux esophagitis and abnormal GEFV did not change.

CONCLUSIONS

Reflux esophagitis and Barrett's epithelium are associated with abnormal GEFV in Japanese patients. The presence of atrophic gastritis is inversely related to reflux esophagitis, but it is not related to Barrett's epithelium in Japanese patients.

摘要

背景

胃食管瓣（GEFV）的内镜分级是胃食管反流状态的一个有用预测指标；GEFV异常与反流性食管炎相关。萎缩性胃炎在日本患者中较为常见，且与反流性食管炎呈负相关。本研究的目的是通过前瞻性内镜评估，研究日本患者中GEFV、反流性食管炎、巴雷特食管上皮化生和萎缩性胃炎之间的关联。

方法

我们纳入了548名日本患者（男性296名，女性252名；平均年龄57.3岁）。GEFV采用Hill等人的分类法进行评估，反流性食管炎采用洛杉矶分类法进行评估，萎缩性胃炎的程度分为：无、轻度、中度或重度。通过内镜检测柱状上皮向上移位来识别巴雷特食管上皮化生。

结果

分别有42名（7.7%）和67名（12.2%）患者发现反流性食管炎和巴雷特食管上皮化生。反流性食管炎和巴雷特食管上皮化生患病率的增加与GEFV分级的增加相关。GEFV异常（III级和IV级）是反流性食管炎（调整后的优势比[OR]）的危险因素，为13.33（95%置信区间[CI]，6.08 - 29.25）以及巴雷特食管上皮化生（OR，3.55[95%CI，2.04 - 6.20]），而萎缩性胃炎的存在与反流性食管炎呈负相关（OR，0.15[95%CI，0.07 - 0.36]），但与巴雷特食管上皮化生的患病率无关（OR，1.16[95%CI，0.67 - 2.01]）。巴雷特食管上皮化生的患病率和萎缩性胃炎的严重程度随年龄增加而升高，而反流性食管炎和GEFV异常的患病率则无变化。