Nason Katie S, Wichienkuer Promporn Paula, Awais Omar, Schuchert Matthew J, Luketich James D, O'Rourke Robert W, Hunter John G, Morris Cynthia D, Jobe Blair A
Division of Thoracic and Foregut Surgery, Universty of Pittsburgh, Pittsburgh, PA 15232, USA.
Arch Surg. 2011 Jul;146(7):851-8. doi: 10.1001/archsurg.2011.174.
Screening for esophageal adenocarcinoma has focused on identifying Barrett esophagus (BE) in patients with severe, long-standing symptoms of gastroesophageal reflux disease (GERD). Unfortunately, 95% of patients who develop esophageal adenocarcinoma are unaware of the presence of BE before their cancer diagnosis, which means they never had been selected for screening. One possible explanation is that no correlation exists between the severity of GERD symptoms and cancer risk. We hypothesize that severe GERD symptoms are not associated with an increase in the prevalence of BE, dysplasia, or cancer in patients undergoing primary endoscopic screening.
Cross-sectional study.
University hospital.
A total of 769 patients with GERD.
Primary screening endoscopy performed from November 1, 2004, through June 7, 2007.
Symptom severity, proton pump inhibitor therapy, and esophageal adenocarcinogenesis (ie, BE, dysplasia, or cancer).
Endoscopy revealed adenocarcinogenesis in 122 patients. An increasing number of severe GERD symptoms correlated positively with endoscopic findings of esophagitis (odds ratio, 1.05; 95% confidence interval, 1.01-1.09). Conversely, an increasing number of severe GERD symptoms were associated with decreased odds of adenocarcinogenesis (odds ratio, 0.94; 95% confidence interval, 0.89-0.98). Patients taking proton pump inhibitors were 61.3% and 81.5% more likely to have adenocarcinogenesis if they reported no severe typical or atypical GERD symptoms, respectively, compared with patients taking proton pump inhibitors, who reported that all symptoms were severe.
Medically treated patients with mild or absent GERD symptoms have significantly higher odds of adenocarcinogenesis compared with medically treated patients with severe GERD symptoms. This finding may explain the failure of the current screening paradigm in which the threshold for primary endoscopic examination is based on symptom severity.
食管腺癌筛查主要集中于识别患有严重、长期胃食管反流病（GERD）症状的患者中的巴雷特食管（BE）。遗憾的是，95%发生食管腺癌的患者在癌症诊断前并不知道自己存在BE，这意味着他们从未被选作筛查对象。一种可能的解释是，GERD症状的严重程度与癌症风险之间不存在相关性。我们推测，在接受初次内镜筛查的患者中，严重GERD症状与BE、发育异常或癌症的患病率增加无关。
横断面研究。
大学医院。
共769例GERD患者。
2004年11月1日至2007年6月7日进行初次筛查内镜检查。
症状严重程度、质子泵抑制剂治疗情况以及食管腺癌发生情况（即BE、发育异常或癌症）。
内镜检查发现122例患者存在腺癌发生情况。GERD严重症状数量增加与食管炎的内镜检查结果呈正相关（比值比，1.05；95%置信区间，1.01 - 1.09）。相反，GERD严重症状数量增加与腺癌发生几率降低相关（比值比，0.94；95%置信区间，0.89 - 0.98）。与报告所有症状均严重的服用质子泵抑制剂的患者相比，报告无严重典型或非典型GERD症状的服用质子泵抑制剂的患者发生腺癌的可能性分别高出61.3%和81.5%。
与接受药物治疗且有严重GERD症状的患者相比，接受药物治疗但GERD症状轻微或无症状的患者发生腺癌的几率显著更高。这一发现可能解释了当前筛查模式的失败，即初次内镜检查的阈值是基于症状严重程度。
