Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan 48109, USA.
Am J Gastroenterol. 2013 Mar;108(3):353-62. doi: 10.1038/ajg.2012.446. Epub 2013 Jan 15.
Risk factors for Barrett's esophagus include gastroesophageal reflux disease (GERD) symptoms, age, abdominal obesity, and tobacco use. We aimed to develop a tool using these factors to predict the presence of Barrett's esophagus.
Male colorectal cancer (CRC) screenees were recruited to undergo upper endoscopy, identifying newly diagnosed cases of Barrett's esophagus. Logistic regression models predicting Barrett's esophagus using GERD symptoms alone and together with abdominal obesity, tobacco use, and age were compared.
Barrett's esophagus was found in 70 (8.5%) of 822 CRC screenees. Mutually adjusting for other covariates, Barrett's esophagus was associated with weekly GERD (odds ratio (OR)=2.33, 95% confidence interval (CI)=1.34, 4.05), age (OR per 10 years=1.53, 95% CI=1.05, 2.25), waist-to-hip ratio (OR per 0.10=1.44, 95% CI=0.898, 2.32) and pack-years of cigarette use (OR per 10 pack-years=1.09, 95% CI=1.04, 1.14). A model including those four factors had a greater area under the receiver operating characteristics curve than did a model based on GERD frequency and duration alone (0.72 vs. 0.61, P<0.001), and it had a net reclassification improvement index of 19-25%.
The prevalence of Barrett's esophagus was substantial in our population of older overweight men. A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barrett's esophagus than did a model based on GERD alone. Following validation of the tool in another population, its use in clinical practice might improve the efficiency of screening for Barrett's esophagus.
巴雷特食管的危险因素包括胃食管反流病（GERD）症状、年龄、腹部肥胖和吸烟。我们旨在开发一种使用这些因素来预测巴雷特食管存在的工具。
招募男性结直肠癌（CRC）筛查者进行上内窥镜检查，确定新诊断的巴雷特食管病例。比较仅使用 GERD 症状以及同时使用腹部肥胖、吸烟和年龄预测巴雷特食管的逻辑回归模型。
在 822 名 CRC 筛查者中发现了 70 名（8.5%）巴雷特食管。在相互调整其他协变量后，巴雷特食管与每周 GERD（优势比（OR）=2.33，95%置信区间（CI）=1.34，4.05）、年龄（每 10 年增加 1.53，95%CI=1.05，2.25）、腰围-臀围比（每 0.10 增加 1.44，95%CI=0.898，2.32）和吸烟包年数（每 10 包年增加 1.09，95%CI=1.04，1.14）相关。一个包含这四个因素的模型比仅基于 GERD 频率和持续时间的模型具有更大的接收者操作特征曲线下面积（0.72 对 0.61，P<0.001），并且它具有 19-25%的净重新分类改善指数。
在我们的超重老年男性人群中，巴雷特食管的患病率相当高。基于 GERD、年龄、腹部肥胖和吸烟的模型比仅基于 GERD 的模型更准确地分类巴雷特食管的存在。在另一个人群中验证该工具后，其在临床实践中的使用可能会提高巴雷特食管筛查的效率。
