Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Am J Gastroenterol. 2010 May;105(5):1039-45. doi: 10.1038/ajg.2009.629. Epub 2009 Nov 10.
Proton pump inhibitors (PPIs) are frequently prescribed to patients with Barrett's esophagus (BE), but in a subset, they can induce significant hypergastrinemia. Elevated levels of gastrin have been associated with tumorigenic effects in a number of gastrointestinal cancers. We decided to investigate the association between serum gastrin levels and dysplasia in BE.
We performed a cross-sectional study and enrolled patients with BE without dysplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), or adenocarcinoma (AC), as well as gastroesophageal reflux disease controls, all chronically taking PPIs. Fasting serum gastrin was measured, and data were collected on patient characteristics, medication use, and the highest degree of BE neoplasia.
A total of 95 patients were enrolled. The mean age was 64.7 (+/-10.0) years, and 70.5% were male. The median serum gastrin level was 40 pM. There was no significant difference in gastrin levels with increased degrees of BE neoplasia (overall P=0.68). In multivariable analysis, the highest quartile of gastrin was associated with significantly increased odds of advanced neoplasia (HGD or AC) (odds ratio (OR): 5.46, 95% confidence interval (CI): 1.20-24.8).
In BE patients taking PPIs, an elevated serum gastrin is associated with a history of HGD or AC. Prospective studies are needed to determine whether patients with nondysplastic BE and elevated serum gastrin are at increased risk for neoplastic progression.
质子泵抑制剂 (PPI) 常被用于治疗 Barrett 食管 (BE) 患者，但在一部分患者中，它们可引起显著的高胃泌素血症。胃泌素水平升高与多种胃肠道癌症的致瘤作用有关。我们决定研究 BE 中血清胃泌素水平与异型增生之间的关系。
我们进行了一项横断面研究，纳入了无异型增生、低级别异型增生 (LGD)、高级别异型增生 (HGD) 或腺癌 (AC) 的 BE 患者以及胃食管反流病对照患者，所有患者均长期服用 PPI。测量空腹血清胃泌素，并收集患者特征、药物使用情况以及 BE 肿瘤最高程度的数据。
共纳入 95 例患者。平均年龄为 64.7(+/-10.0)岁，70.5%为男性。中位血清胃泌素水平为 40pM。随着 BE 肿瘤程度的增加，胃泌素水平没有显著差异(总体 P=0.68)。多变量分析显示，胃泌素最高四分位数与高级别异型增生 (HGD 或 AC) 的发生几率显著增加相关(比值比 (OR)：5.46，95%置信区间 (CI)：1.20-24.8)。
在服用 PPI 的 BE 患者中，血清胃泌素升高与 HGD 或 AC 病史相关。需要前瞻性研究来确定非异型增生性 BE 且血清胃泌素升高的患者是否有更高的肿瘤进展风险。
