Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Clin Gastroenterol Hepatol. 2012 Dec;10(12):1369-75. doi: 10.1016/j.cgh.2012.09.014. Epub 2012 Sep 16.
BACKGROUND & AIMS: The association between gastroesophageal reflux and esophageal adenocarcinoma is likely to be mediated by inflammation. Reflux is common in infancy; the esophageal mucosa of infants born preterm or small for gestational age (SGA) could be particularly vulnerable. We investigated the association between preterm or SGA birth and risk of esophagitis early in life.
We analyzed data from the Swedish birth register and the Swedish patient register to identify birth characteristics of individuals with endoscopically verified esophagitis from 1973 to 2007 and to determine their outcomes (7358 cases). Five controls were selected randomly and matched with each case (N = 38,479). Multivariable conditional logistic regression models were used to provide odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential confounding.
The risk of esophagitis was increased among individuals born preterm (≤32 gestational weeks) (OR, 2.74; 95% CI, 2.15-3.49) or SGA (OR, 1.49; 95% CI, 1.32-1.68). When data were stratified by age at diagnosis and by sex, different risk patterns appeared. Among individuals diagnosed with esophagitis 9 years of age and younger, the OR for prematurity was 6.82 (95% CI, 4.65-10.03) and the OR for SGA at birth was 1.98 (95% CI, 1.55-2.52). Furthermore, the association with preterm birth was stronger among males (OR, 9.88; 95%, CI 5.93-16.45) than females (OR, 3.41; 95% CI, 1.81-6.41), whereas the association with SGA was stronger among females (OR, 2.50; 95% CI, 1.76-3.55) than males (OR, 1.64; 95% CI, 1.16-2.30). The risk of being diagnosed with esophagitis at age 20 or younger was not associated with preterm birth (OR, 1.02; 95% CI, 0.64-1.63), but was associated with being SGA at birth (OR, 1.31; 95% CI, 1.11-1.54).
Preterm birth is associated with esophagitis only during childhood, whereas SGA birth is associated with esophagitis during adolescence as well. The associations appear to differ between sexes.
胃食管反流与食管腺癌之间的关联可能是由炎症介导的。反流在婴儿期很常见；早产儿或小于胎龄儿（SGA）的食管黏膜可能特别容易受到影响。我们研究了早产儿或 SGA 出生与生命早期食管炎风险之间的关系。
我们分析了 1973 年至 2007 年瑞典出生登记处和瑞典患者登记处的数据，以确定内镜证实的食管炎患者的出生特征，并确定他们的结局（7358 例）。随机选择 5 名对照者与每个病例匹配（N=38479）。使用多变量条件逻辑回归模型提供比值比（OR）和 95%置信区间（CI），并调整了潜在混杂因素。
出生时患有早产儿（≤32 周妊娠）（OR，2.74；95%CI，2.15-3.49）或 SGA（OR，1.49；95%CI，1.32-1.68）的个体患食管炎的风险增加。当按诊断时的年龄和性别对数据进行分层时，出现了不同的风险模式。在 9 岁及以下被诊断为食管炎的个体中，早产的 OR 为 6.82（95%CI，4.65-10.03），出生时 SGA 的 OR 为 1.98（95%CI，1.55-2.52）。此外，与早产相关的关联在男性中比女性更强（OR，9.88；95%CI，5.93-16.45），而与 SGA 相关的关联在女性中比男性更强（OR，2.50；95%CI，1.76-3.55），而男性的 OR 为 1.64（95%CI，1.16-2.30）。20 岁及以下被诊断为食管炎的风险与早产无关（OR，1.02；95%CI，0.64-1.63），但与出生时 SGA 相关（OR，1.31；95%CI，1.11-1.54）。
早产仅与儿童时期的食管炎相关，而 SGA 出生与青春期的食管炎相关。这些关联似乎在性别之间存在差异。
