Koek G H, Sifrim D, Lerut T, Janssens J, Tack J
Center for Gastroenterological Research, University Hospital Gasthuisberg, Leuven, Belgium.
Gut. 2008 Aug;57(8):1056-64. doi: 10.1136/gut.2006.119206. Epub 2008 Apr 10.
Exposure to acid and duodeno-gastro-oesophageal reflux (DGOR) both increase with oesophageal lesions in gastro-oesophageal reflux disease (GORD). It is unknown whether DGOR exposure is an independent risk factor for oesophageal lesions. A multivariate analysis was performed on the relationship between oesophageal lesions and demographics and acid and DGOR exposure.
In 422 patients with suspected GORD, upper endoscopy, oesophageal manometry, and pH and DGOR monitoring were performed. Stepwise logistic regression was used to identify factors associated with the presence of oesophagitis, severity of oesophagitis and the presence of Barrett's oesophagus. ORs and 95% CIs were computed at different cut-offs.
54% of the patients had no oesophagitis, 36% had grade A-B oesophagitis, 3% had grade C-D oesophagitis and 7% had Barrett's oesophagus. In multivariate analysis, oesophagitis was associated with hiatal hernia (OR 3.621, 95% CI 2.263 to 5.794) and DGOR exposure (OR up to 2.236, 95% CI 1.356-3.685), while a low body mass index (BMI) seemed protective (OR for BMI >first quartile 2.245, 95% CI 1.371 to 3.677). Severity of oesophagitis was only associated with acid exposure (OR up to 5.038, 95% CI 1.452 to 17.480). The presence of Barrett's oesophagus was associated with male sex (OR 3.621, 95% CI 2.263 to 5.794), DGOR (OR up to 5.017, 95% CI 2.051 to 12.274) and acid exposure (OR up to 3.031, 95% CI 1.216 to 7.556).
Several independent factors are associated with oesophageal lesions in GORD. The risk of oesophagitis is associated with hiatal hernia, BMI and DGOR exposure; severity of oesophagitis depends on acid exposure; and Barrett's oesophagus is associated with male sex and exposure to both acid and DGOR.
在胃食管反流病（GORD）中，胃酸暴露和十二指肠-胃-食管反流（DGOR）均随食管病变而增加。尚不清楚DGOR暴露是否为食管病变的独立危险因素。对食管病变与人口统计学、胃酸及DGOR暴露之间的关系进行了多因素分析。
对422例疑似GORD患者进行了上消化道内镜检查、食管测压以及pH值和DGOR监测。采用逐步逻辑回归分析确定与食管炎的存在、食管炎的严重程度以及巴雷特食管的存在相关的因素。在不同的临界值下计算比值比（OR）和95%置信区间（CI）。
54%的患者无食管炎，36%的患者有A级至B级食管炎，3%的患者有C级至D级食管炎，7%的患者有巴雷特食管。多因素分析显示，食管炎与食管裂孔疝（OR 3.621，95%CI 2.263至5.794）和DGOR暴露（OR高达2.236，95%CI 1.356 - 3.685）相关，而低体重指数（BMI）似乎具有保护作用（BMI>第一四分位数时的OR为2.245，95%CI 1.371至3.677）。食管炎的严重程度仅与胃酸暴露相关（OR高达5.038，95%CI 1.452至17.480）。巴雷特食管的存在与男性（OR 3.621，95%CI 2.263至5.794）、DGOR（OR高达5.017，95%CI 2.051至12.274）和胃酸暴露（OR高达3.031，95%CI 1.216至7.556）相关。
GORD中食管病变与多个独立因素相关。食管炎的风险与食管裂孔疝、BMI和DGOR暴露相关；食管炎的严重程度取决于胃酸暴露；巴雷特食管与男性以及胃酸和DGOR暴露均相关。
