Modiano Nir, Gerson Lauren B
Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA.
Gastrointest Endosc. 2009 May;69(6):1014-20. doi: 10.1016/j.gie.2008.07.024. Epub 2009 Jan 18.
Barrett's esophagus (BE) results from metaplastic healing of injured esophageal mucosa after erosive esophagitis (EE).
Our purpose was to determine whether severity of esophagitis, indication for endoscopy, or proton pump inhibitor treatment affects the subsequent incidence of BE diagnosis in patients found to have EE on EGD performed for any indication.
We identified patients with primary or secondary International Classification of Diseases, 9th revision diagnosis codes of EE from 1996 to 2006 who had at least 2 EGDs on record. Patients with prevalent BE on the first EGD were excluded.
Inpatients and outpatients at Stanford University and Palo Alto Veterans Affairs Health Care System.
Retrospective review of EGD and pathology reports to confirm BE.
Detection of BE after diagnosis of EE.
A total of 1095 patients were identified between 1996 and 2000, and 102 (9%) were included. Sixty-two (61%) patients were veterans, 87 (85%) were male, and 83 (81%) were white. The mean (+/-SD) age was 58 +/- 14 years (range 24-83 years). BE was detected in 9 (9%) patients (95% CI, 4.5%-17.6%) over a mean of 13.3 +/- 5.7 months (range 1-53.5 months), and all had prior grade 4 esophagitis. The mean BE length was 4 +/- 1.8 cm (range 1-18 cm). Six patients had upper GI bleeding as the indication for EGD, whereas the other 3 complained of dysphagia. The association of grade 4 esophagitis (P = .01) and GI hemorrhage (P = .01) to the subsequent detection of BE was highly statistically significant.
Retrospective study, small number of patients with BE after EE. All patients were receiving care at tertiary medical centers.
BE was detected in 9% of patients with prior EE and was detected exclusively on follow-up of patients with severe esophagitis. The majority of the patients found to have BE had upper GI bleeding as the presentation for EGD.
巴雷特食管（BE）是由糜烂性食管炎（EE）后受损食管黏膜的化生愈合所致。
我们的目的是确定食管炎的严重程度、内镜检查指征或质子泵抑制剂治疗是否会影响因任何指征接受上消化道内镜检查（EGD）且被诊断为EE的患者后续BE诊断的发生率。
我们确定了1996年至2006年患有原发性或继发性国际疾病分类第九版EE诊断编码且有至少2次EGD记录的患者。首次EGD时患有BE的患者被排除。
斯坦福大学和帕洛阿尔托退伍军人事务医疗保健系统的住院患者和门诊患者。
回顾性审查EGD和病理报告以确诊BE。
EE诊断后BE的检测情况。
1996年至2000年共确定了1095例患者，其中102例（9%）被纳入。62例（61%）患者为退伍军人，87例（85%）为男性，83例（81%）为白人。平均（±标准差）年龄为58±14岁（范围24 - 83岁）。在平均13.3±5.7个月（范围1 - 53.5个月）内，9例（9%）患者（95%可信区间，4.5% - 17.6%）检测到BE，且所有患者既往均有4级食管炎。BE的平均长度为4±1.8厘米（范围1 - 18厘米）。6例患者以上消化道出血作为EGD的指征，而其他3例主诉吞咽困难。4级食管炎（P = 0.01）和消化道出血（P = 0.01）与后续BE检测的关联具有高度统计学意义。
回顾性研究，EE后患有BE的患者数量较少。所有患者均在三级医疗中心接受治疗。
既往患有EE的患者中9%检测到BE，且仅在重度食管炎患者的随访中检测到。大多数被发现患有BE的患者以上消化道出血作为EGD的表现。
