El-Serag Hashem B, Aguirre Thomas V, Davis Stephanie, Kuebeler Mark, Bhattacharyya Achyut, Sampliner Richard E
Sections of Gastroenterology and Health Services Research, The Houston Center for Quality of Care and Utilization Studies, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA.
Am J Gastroenterol. 2004 Oct;99(10):1877-83. doi: 10.1111/j.1572-0241.2004.30228.x.
BACKGROUND AND AIMS: Esophageal acid exposure is important in the pathogenesis of Barrett's esophagus (BE), and possibly in the progression of BE to dysplasia and carcinoma. The aim of this study is to compare the development of dysplasia in BE patients treated with or without proton pump inhibitor (PPI) or histamine 2-receptor antagonist (H2RA). METHODS: We analyzed prospectively collected data by a single endoscopist on patients with BE in a VA (Veterans Affairs) setting over a 20-yr time period (1981-2000). A pathologist used standard criteria to diagnose BE/dysplasia. Pharmacy information after 1994 was retrieved from a computerized database, and from research files for the period before that. The receipt and the duration of H2RA and/or PPI use was compared between those with and without dysplasia. The incidence of dysplasia was examined in a Kaplan-Meier survival analysis stratified by PPI treatment status, and the risk of dysplasia was examined in a Cox multiple regression analysis controlling for demographic features, length of BE, and the year of BE diagnosis. RESULTS: We analyzed data for 236 unique veteran patients with a mean age at BE diagnosis of 61.5 yr, 86% Caucasian, and 98% male. During 1,170 patient-yr of follow-up, 56 patients developed dysplasia giving an annual incidence rate of 4.7%. Of those, 14 had high-grade dysplasia. The cumulative incidence of dysplasia was significantly lower among patients who received PPI after BE diagnosis than in those who received no therapy or H2RA; log rank test (p < 0.001). Furthermore, among those on PPIs, a longer duration of use was associated with less frequent occurrence of dysplasia. In multivariate analysis, the use of PPI after BE diagnosis was independently associated with reduced risk of dysplasia, hazards ratio: 0.25 (95% CI 0.13-0.47), p < 0.0001. Longer segments of BE and Caucasian race were other independent risk factors for developing dysplasia. In general, similar findings were observed when only cases with high-grade dysplasia were analyzed. CONCLUSIONS: These results indicate that PPI therapy is associated with a significant reduction in the risk of developing dysplasia in patients with BE. However, more studies are required to confirm this finding.
背景与目的：食管酸暴露在巴雷特食管（BE）的发病机制中具有重要作用，并且可能在BE进展为发育异常和癌症的过程中起作用。本研究的目的是比较接受或未接受质子泵抑制剂（PPI）或组胺2受体拮抗剂（H2RA）治疗的BE患者发育异常的发生情况。 方法：我们分析了一位内镜医师在20年期间（1981 - 2000年）在退伍军人事务部（VA）环境中前瞻性收集的BE患者数据。病理学家使用标准标准诊断BE/发育异常。1994年之后的药房信息从计算机数据库中获取，在此之前的时期则从研究档案中获取。比较了有发育异常和无发育异常患者使用H2RA和/或PPI的情况及使用持续时间。在按PPI治疗状态分层的Kaplan-Meier生存分析中检查发育异常的发生率，并在控制人口统计学特征、BE长度和BE诊断年份的Cox多元回归分析中检查发育异常的风险。 结果：我们分析了236例独特的退伍军人患者的数据，这些患者BE诊断时的平均年龄为61.5岁，86%为白种人，98%为男性。在1170患者年的随访期间，56例患者发生发育异常，年发病率为4.7%。其中，14例为高级别发育异常。BE诊断后接受PPI治疗的患者中发育异常的累积发生率显著低于未接受治疗或接受H2RA治疗的患者；对数秩检验（p < 0.001）。此外，在使用PPI的患者中，使用时间越长，发育异常的发生频率越低。在多变量分析中，BE诊断后使用PPI与发育异常风险降低独立相关，风险比：0.25（95%CI 0.13 - 0.47），p < 0.0001。BE较长节段和白种人是发生发育异常的其他独立危险因素。总体而言，仅分析高级别发育异常病例时观察到类似结果。 结论：这些结果表明，PPI治疗与BE患者发生发育异常的风险显著降低相关。然而，需要更多研究来证实这一发现。
Am J Gastroenterol. 2004-10
Aliment Pharmacol Ther. 2008-2-15
Aliment Pharmacol Ther. 2004-6-15
Am J Gastroenterol. 1999-12
Gastrointest Endosc. 2005-11
Am J Gastroenterol. 2004-9
Curr Gastroenterol Rep. 2023-12
Medicine (Baltimore). 2022-12-9
Acta Biomed. 2022-3-14
Cancers (Basel). 2022-1-20
Front Genet. 2021-9-17
Therap Adv Gastroenterol. 2021-8-19
Cancers (Basel). 2021-5-1
Genes (Basel). 2019-11-14
Zotero 插件