Smith Kylie J, O'Brien Suzanne M, Smithers B Mark, Gotley David C, Webb Penelope M, Green Adèle C, Whiteman David C
Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Queensland 4029, Australia.
Cancer Epidemiol Biomarkers Prev. 2005 Nov;14(11 Pt 1):2481-6. doi: 10.1158/1055-9965.EPI-05-0370.
Barrett's esophagus, a metaplastic precursor to esophageal adenocarcinoma, is becoming increasingly prevalent in many populations. Clinical studies suggest acid reflux causes Barrett's esophagus; however, no population-based estimates of risk have been reported, and the role of other health factors in modifying risk is unclear.
We conducted a population-based case-control study in Brisbane, Australia. Cases were 167 patients with histologically confirmed Barrett's esophagus diagnosed between February and December 2003. Age-matched and sex-matched controls (n = 261) were randomly selected from a population register. Data on exposure to self-reported symptoms of acid reflux, smoking, obesity, and other factors were collected through self-completed questionnaires followed by telephone interview. Risks of Barrett's esophagus and Barrett's esophagus with dysplasia associated with these exposures were estimated by the odds ratio (OR) and 95% confidence interval (95% CI), both crude and adjusted for other factors.
Self-reported weekly episodes of acid reflux were associated with greatly increased risks of Barrett's esophagus (adjusted OR, 29.7; 95% CI, 12.2-72.6) and Barrett's esophagus with dysplasia (OR, 59.7; 95% CI, 18.5-193). Smoking was also associated with risk of Barrett's esophagus. We found evidence of interactions between symptoms of acid reflux and smoking and obesity. Obese people with self-reported symptoms of acid reflux had markedly higher risks of Barrett's esophagus (OR, 34.4; 95% CI, 6.3-188) than people with reflux alone (OR, 9.3; 95% CI, 1.4-62.2) or obesity alone (OR, 0.7; 95% CI, 0.2-2.4). Similarly, those reporting both acid reflux symptoms and smoking were at substantially higher risks of Barrett's esophagus (OR, 51.4; 95% CI, 14.1-188) than those reporting acid reflux or smoking alone.
Although history of symptoms of acid reflux is the principle factor associated with Barrett's esophagus, risks are substantially increased by obesity and smoking.
巴雷特食管是食管腺癌的一种化生前驱病变，在许多人群中越来越普遍。临床研究表明胃酸反流会导致巴雷特食管；然而，尚未有基于人群的风险估计报告，且其他健康因素在改变风险方面的作用尚不清楚。
我们在澳大利亚布里斯班进行了一项基于人群的病例对照研究。病例为2003年2月至12月间经组织学确诊的167例巴雷特食管患者。年龄和性别匹配的对照（n = 261）从人口登记册中随机选取。通过自行填写问卷并随后进行电话访谈收集关于自我报告的胃酸反流症状、吸烟、肥胖及其他因素暴露的数据。通过比值比（OR）和95%置信区间（95%CI）估计与这些暴露相关的巴雷特食管及发育异常的巴雷特食管的风险，包括粗风险和经其他因素调整后的风险。
自我报告每周出现胃酸反流发作与巴雷特食管风险大幅增加相关（调整后的OR，29.7；95%CI，12.2 - 72.6）以及与发育异常的巴雷特食管相关（OR，59.7；95%CI，18.5 - 193）。吸烟也与巴雷特食管风险相关。我们发现胃酸反流症状与吸烟及肥胖之间存在相互作用的证据。自我报告有胃酸反流症状的肥胖者患巴雷特食管的风险（OR，34.4；95%CI，6.3 - 188）明显高于仅患有反流者（OR，9.3；95%CI，1.4 - 62.2）或仅肥胖者（OR，0.7；95%CI，0.2 - 2.4）。同样，那些同时报告有胃酸反流症状和吸烟的人患巴雷特食管的风险（OR，51.4；95%CI，14.1 - 188）明显高于仅报告有胃酸反流或吸烟的人。
虽然胃酸反流症状史是与巴雷特食管相关的主要因素，但肥胖和吸烟会大幅增加风险。
