Alcedo Javier, Ferrández Angel, Arenas Juan, Sopeña Federico, Ortego Javier, Sainz Ricardo, Lanas Angel
Service of Digestive Diseases, Clínico Lozano Blesa Hospital, Institute of Health Sciences, CIBERehd, University of Zaragoza, Zaragoza, Spain.
Dis Esophagus. 2009;22(3):239-48. doi: 10.1111/j.1442-2050.2008.00908.x.
The incidence of Barrett's esophagus (BE) and esophageal adenocarcinoma has increased in Western countries in recent decades. The aim of this study is to describe the changes in incidence and prevalence of BE diagnosis, dysplasia, and adenocarcinoma development in BE patients in a South-European Mediterranean area. Retrospective population-based analyses of endoscopy and pathology reports from 1976 to 2001 was performed. Data from patients with diagnosis of BE and/or esophageal carcinoma were collected. The study period was divided in four quartiles for statistical calculations; parametric and nonparametric tests were used. A 6.9-fold increase was found in the diagnosis of long-segment BE from the first to the fourth quartile, and a 9.3-fold increase in short-segment BE from 1995 to 2000, in contrast to a much smaller increase of 1.9-fold increase in the number of upper gastrointestinal endoscopies. The adjusted incidence of BE diagnosis increased from 0.73 to 9.73 cases/100,000 (first to fourth quartile, respectively) and the adjusted prevalence from 6.51 to 76.04 cases/100,000 (1985-2001). The incidence of dysplasia was 2.13% per year (95% confidence interval: 0.05-11.3%) - 1.78% for low-grade dysplasia and 0.36% for high-grade dysplasia - giving a total incidence of 1 per 47 patient-years. The incidence of adenocarcinoma during follow-up was 0.48% per year (95% confidence interval: 0.006-2.62%), for an incidence of 1 per 210 patient-years. Nineteen patients with BE (14 long-segment BE, 5 short-segment BE) were diagnosed with esophageal adenocarcinoma, with eight being diagnosed during endoscopic surveillance. Only 14 (8%) adenocarcinoma patients diagnosed during the study period had a history of BE. BE diagnosis has dramatically increased over recent decades in our population, unrelated to an increase in endoscopies. Progression to low-grade dysplasia and adenocarcinoma is rare. Surveillance may have a low impact on the survival of adenocarcinoma patients in Southern Europe.
近几十年来，西方国家巴雷特食管（BE）和食管腺癌的发病率有所上升。本研究旨在描述南欧地中海地区BE患者中BE诊断、发育异常及腺癌发生的发病率和患病率变化。对1976年至2001年的内镜检查和病理报告进行基于人群的回顾性分析。收集诊断为BE和/或食管癌患者的数据。研究期分为四个四分位数进行统计计算；使用参数检验和非参数检验。从第一个四分位数到第四个四分位数，长段BE的诊断增加了6.9倍，短段BE在1995年至2000年增加了9.3倍，而上消化道内镜检查数量仅增加了1.9倍。BE诊断的校正发病率从0.73例/10万增加到9.73例/10万（分别为第一个和第四个四分位数），校正患病率从6.51例/10万增加到76.04例/10万（1985 - 2001年）。发育异常的发病率为每年2.13%（95%置信区间：0.05 - 11.3%），低级别发育异常为1.78%，高级别发育异常为0.36%，每47患者年的总发病率为1例。随访期间腺癌的发病率为每年0.48%（95%置信区间：0.006 - 2.62%），每210患者年的发病率为1例。19例BE患者（14例长段BE，5例短段BE）被诊断为食管腺癌，其中8例在内镜监测期间被诊断。在研究期间诊断的腺癌患者中，只有14例（8%）有BE病史。近几十年来，我们人群中BE诊断显著增加，与内镜检查增加无关。进展为低级别发育异常和腺癌的情况很少见。监测对南欧腺癌患者的生存率可能影响较小。
