Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Am J Gastroenterol. 2013 Oct;108(10):1576-83. doi: 10.1038/ajg.2013.222. Epub 2013 Jul 16.
This study examined Barrett's esophagus (BE) risk factors in veterans to determine the association between risk of BE and use of oral bisphosphonates.
We conducted a case-control study among eligible patients scheduled for an elective esophagogastroduodenoscopy (EGD) and a sample of patients eligible for screening colonoscopy recruited from primary care clinics from a single VA Medical Center. Cases with definitive BE were compared with controls; all underwent study EGD. Use of oral bisphosphonates was ascertained by reviewing filled prescriptions in electronic pharmacy records. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs), using multivariate logistic regression modeling while adjusting for sex, age, race, proton-pump inhibitor use, hiatal hernia, waist-to-hip ratio, Helicobacter pylori infection, and gastroesophageal reflux disorder (GERD) symptoms.
There were 285 BE cases, 1,122 endoscopy controls, and 496 primary care controls. Alendronate and risedronate were the only oral bisphosphonates prescribed. The proportion of BE cases with filled prescription of oral bisphosphonates (4.6%) was greater than in endoscopy controls (1.6%) or primary care controls (2.9%). In the adjusted analysis, oral bisphosphonate use was significantly associated with BE risk (OR=2.33; 95% CI: 1.11-4.88) compared with the combined control groups. This association remained significant when BE cases were compared with endoscopy controls only (OR=2.74; 95% CI: 1.28-5.87) but was attenuated when compared with primary care controls only (OR=2.60; 95% CI: 0.99-6.84). The association was observed in patients with GERD symptoms (OR=3.29; 95% CI: 1.36-7.97) but not in those without GERD symptoms.
Oral bisphosphonate use may increase the risk for BE, especially among patients with GERD.
本研究旨在探讨退伍军人中 Barrett 食管（BE）的危险因素，以确定 BE 风险与口服双膦酸盐使用之间的关系。
我们在一家退伍军人管理局医疗中心的择期食管胃十二指肠镜检查（EGD）患者中进行了病例对照研究，并在初级保健诊所中招募了符合筛查结肠镜检查条件的患者作为对照。将确诊 BE 的病例与对照进行比较；所有患者均进行了研究 EGD。通过查看电子药房记录中的用药记录来确定口服双膦酸盐的使用情况。我们使用多元逻辑回归模型计算比值比（OR）和 95%置信区间（95%CI），同时调整了性别、年龄、种族、质子泵抑制剂使用、食管裂孔疝、腰臀比、幽门螺杆菌感染和胃食管反流病（GERD）症状。
共有 285 例 BE 病例、1122 例内镜对照和 496 例初级保健对照。仅开了阿伦膦酸盐和利塞膦酸盐这两种口服双膦酸盐。有口服双膦酸盐用药记录的 BE 病例比例（4.6%）高于内镜对照（1.6%）或初级保健对照（2.9%）。在调整分析中，与对照组相比，口服双膦酸盐的使用与 BE 风险显著相关（OR=2.33；95%CI：1.11-4.88）。仅与内镜对照相比，这种相关性仍然显著（OR=2.74；95%CI：1.28-5.87），但与仅与初级保健对照相比，相关性减弱（OR=2.60；95%CI：0.99-6.84）。这种相关性在有 GERD 症状的患者中观察到（OR=3.29；95%CI：1.36-7.97），但在没有 GERD 症状的患者中未观察到。
口服双膦酸盐的使用可能会增加 BE 的风险，尤其是在有 GERD 症状的患者中。
