1999-2009 年吞咽困难病因相对流行率的时间趋势。

Temporal trends in the relative prevalence of dysphagia etiologies from 1999-2009.

机构信息

Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States.

出版信息

World J Gastroenterol. 2012 Aug 28;18(32):4335-41. doi: 10.3748/wjg.v18.i32.4335.

DOI:10.3748/wjg.v18.i32.4335

PMID:22969196

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3436048/

Abstract

AIM

To examine the relative prevalence and temporal variation of dysphagia etiologies in patients undergoing upper endoscopy (EGD) over the past decade.

METHODS

EGDs with the indication of dysphagia at an urban, university medical center in 1999, 2004 and 2009 were retrospectively identified from the electronic medical record. The entire patient chart, including EGD, pathology, manometry, radiographic and clinician reports, was reviewed for demographic and clinical data and to determine the etiology of dysphagia. The number of EGDs in which an esophageal biopsy was performed was also noted. Gastroesophageal reflux disease (GERD) as a cause of dysphagia independent of peptic stricture was defined by symptoms with erosive esophagitis or symptom response to proton pump inhibition (PPI). Cases of eosinophilic esophagitis (EoE) were defined by an appropriate clinical history and histological criteria of ≥ 15 eosinophils per high powered field. PPI-responsive esophageal eosinophilia was not routinely reported prior to 2008. Statistical analysis was performed using one-way analysis of variance to analyze for trends between 1999, 2004 and 2009 and a post-hoc Tukey analysis was performed following a significant main effect.

RESULTS

A total of 1371 cases (mean age 54 years, 43% male) met pre-specified inclusion criteria with 191, 504 and 675 cases in 1999, 2004 and 2009, respectively. Patients were older in 2004 compared to 2009 (mean ± SD, 54.0 ± 15.7 years vs 52.3 ± 16.8 years, P = 0.02) and there were more males in 1999 compared to 2004 (57.5% vs 40.8%, P = 0.005). Overall, GERD (27.6%) and EoE (7.7%) were the most common identifiable causes of dysphagia. An unspecified diagnosis accounted for 21% of overall cases. There were no significant differences in the relative prevalence of achalasia or other motility disorders, peptic stricture, Schatzki's ring, esophageal cancer or unspecified diagnoses over the 10-year time period. There was, however, a decrease in the relative prevalence of GERD (39.3% vs 24.1%, P < 0.001) and increases in the relative prevalence of EoE (1.6% vs 11.2%, P < 0.001) and oropharyngeal disorders (1.6% vs 4.2%, P = 0.02) from 1999 to 2009. Post-hoc analyses determined that the increase in relative prevalence of EoE was significant between 1999 and 2009 as well as 2004 and 2009 (5.4% vs 11.6%, P < 0.001), but not between 1999 and 2004 (1.6% P 5.4%, P = 0.21). On the other hand, the decrease in relative prevalence of GERD was significant between 1999 and 2009 and 1999 and 2004 (39.3% vs 27.7%, P = 0.006), but not between 2004 and 2009 (27.7% vs 24.1%, P = 0.36). There were also significantly more EGDs in which a biopsy was obtained in 1999 compared to 2009 (36.7% vs 68.7%, P < 0.001) as well as between 2004 and 2009 (37.5% vs 68.7%, P < 0.001). While total EGD volume did increase over the 10-year time period, the percentage of EGDs for the indication of dysphagia remained stable making increasing upper endoscopy an unlikely reason for the observed increased prevalence of EoE.

CONCLUSION

EoE has emerged as a dominant cause of dysphagia in adults. Whether this was due to a rise in disease incidence or increased recognition is unclear.

摘要

目的

研究过去十年间因吞咽困难行上消化道内镜（EGD）检查患者的病因相对流行率及其时间变化。

方法

回顾性分析 1999 年、2004 年和 2009 年在城市大学医学中心因吞咽困难行 EGD 的患者的电子病历。通过 EGD、病理、测压、影像学和临床医生报告等方式全面评估患者的人口统计学和临床数据，以确定吞咽困难的病因。还记录了行食管活检的 EGD 数量。胃食管反流病（GERD）被定义为除消化性狭窄外，由有或无食管侵蚀性炎症的症状或质子泵抑制剂（PPI）治疗有效来确定的病因。嗜酸粒细胞性食管炎（EoE）则根据适当的临床病史和高倍镜视野下≥15 个嗜酸性粒细胞的组织学标准来定义。在 2008 年之前，常规报告中并不包括 PPI 反应性食管嗜酸性粒细胞增多症。使用单因素方差分析来分析 1999 年、2004 年和 2009 年之间的趋势，并在主效应有统计学意义时进行事后 Tukey 分析。

结果

共有 1371 例（平均年龄 54 岁，43%为男性）符合预定的纳入标准，1999 年、2004 年和 2009 年分别有 191、504 和 675 例。与 2009 年相比，2004 年患者年龄更大（平均值±标准差，54.0±15.7 岁 vs 52.3±16.8 岁，P=0.02），男性更多（57.5% vs 40.8%，P=0.005）。总体而言，GERD（27.6%）和 EoE（7.7%）是吞咽困难最常见的可识别病因。未明确诊断的病因占所有病例的 21%。在 10 年的时间内，贲门失弛缓症或其他动力障碍、消化性狭窄、Schatzki 环、食管癌或未明确诊断的相对流行率没有显著差异。然而，GERD 的相对流行率（39.3% vs 24.1%，P<0.001）下降，EoE（1.6% vs 11.2%，P<0.001）和口咽疾病（1.6% vs 4.2%，P=0.02）的相对流行率增加。事后分析确定，1999 年至 2009 年、2004 年至 2009 年以及 1999 年至 2004 年 EoE 的相对流行率均显著增加（5.4% vs 11.6%，P<0.001），但 1999 年至 2004 年之间无显著差异（1.6%，P=0.21）。另一方面，GERD 相对流行率的下降在 1999 年至 2009 年和 1999 年至 2004 年之间具有统计学意义（39.3% vs 27.7%，P=0.006），但在 2004 年至 2009 年之间无统计学意义（27.7% vs 24.1%，P=0.36）。1999 年行活检的 EGD 数量也明显多于 2009 年（36.7% vs 68.7%，P<0.001）和 2004 年至 2009 年（37.5% vs 68.7%，P<0.001）。虽然 10 年间总的 EGD 数量有所增加，但吞咽困难的 EGD 比例保持稳定，因此，上消化道内镜检查的增加不太可能是 EoE 患病率增加的原因。