Weston Allan P, Sharma Prateek, Mathur Sharad, Banerjee Sushanta, Jafri A Khatib, Cherian Rachel, McGregor Douglas, Hassanein Ruth S, Hall Matthew
Veterans Administration Medical Center 111C, 4801 E. Linwood Boulevard, Kansas City, MO 64128-2226, USA.
Am J Gastroenterol. 2004 Sep;99(9):1657-66. doi: 10.1111/j.1572-0241.2004.30426.x.
Prospective evaluation of Barrett's esophagus (BE) in order to determine what demographic, endoscopic, and histologic features are predictive of the prevalence and incidence of Barrett's high-grade dysplasia (HGD) and adenocarcinoma (Ca).
Newly diagnosed BE patients were entered into and followed in a standardized surveillance protocol. The following features were examined using either forward, stepwise multiple regression analysis, or Cox proportional hazards to determine their ability to predict the presence of HGD or Ca at index BE diagnosis as well as their ability to predict progression of BE during follow-up: age, race, gender, length of BE in cm, size of a hiatal hernia, severity of dysplasia at index diagnosis as well as during surveillance, gastric Helicobacter pylori infection status, and type of medical acid-reflux treatment.
A total of 550 patients were diagnosed with BE over the study period. Stepwise multiple regression analysis showed three factors significantly associated with index diagnosis of HGD or Ca: hiatal hernia (larger size), Barrett's length (longer length), and absence of H. pylori infection. Three hundred and twenty-four BE entered the surveillance protocol. Cox proportional hazards models revealed a significant and independent association for five factors predictive of the time to progression of BE: presence of dysplasia at index diagnosis (p < 0.001), severity of dysplasia during surveillance (p < 0.001), length of Barrett's epithelium (p= 0.012), size of hiatal hernia (p= 0.006), and gastric H. pylori infection status (p= 0.023).
Endoscopic and histologic features of BE at initial diagnosis are predictive of index HGD and cancer as well as with risk of BE progression.
对巴雷特食管（BE）进行前瞻性评估，以确定哪些人口统计学、内镜和组织学特征可预测巴雷特高级别异型增生（HGD）和腺癌（Ca）的患病率及发病率。
将新诊断的BE患者纳入标准化监测方案并进行随访。使用向前逐步多元回归分析或Cox比例风险模型检查以下特征，以确定它们预测初次BE诊断时HGD或Ca的存在以及预测随访期间BE进展的能力：年龄、种族、性别、BE长度（以厘米为单位）、食管裂孔疝大小、初次诊断及监测期间的异型增生严重程度、胃幽门螺杆菌感染状况以及胃酸反流治疗类型。
在研究期间，共有550例患者被诊断为BE。逐步多元回归分析显示，有三个因素与HGD或Ca的初次诊断显著相关：食管裂孔疝（较大尺寸）、巴雷特长度（较长）以及无幽门螺杆菌感染。324例BE患者进入监测方案。Cox比例风险模型显示，有五个因素与BE进展时间的预测具有显著且独立的关联：初次诊断时存在异型增生（p < 0.001）、监测期间异型增生的严重程度（p < 0.001）、巴雷特上皮长度（p = 0.012）、食管裂孔疝大小（p = 0.006）以及胃幽门螺杆菌感染状况（p = 0.023）。
初次诊断时BE的内镜和组织学特征可预测初次HGD和癌症以及BE进展风险。
