Tan Mimi C, Murrey-Ittmann Jackson, Nguyen Theresa, Ketwaroo Gyanprakash A, El-Serag Hashem B, Thrift Aaron P
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States of America.
Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, United States of America.
PLoS One. 2016 Dec 30;11(12):e0169250. doi: 10.1371/journal.pone.0169250. eCollection 2016.
Previous studies on Barrett's esophagus (BE) risk factors have had differing case definitions and control groups. The purpose of this study was to examine differences in risk factors between newly diagnosed vs. prevalent BE, long- vs. short-segment BE, and endoscopy-only BE without specialized intestinal metaplasia (SIM).
We conducted a cross-sectional study among eligible patients scheduled for elective esophagogastroduodenoscopy (EGD) and patients eligible for screening colonoscopy, recruited from primary care clinics at a Veterans Affairs center. All participants completed a survey on demographics, gastroesophageal reflux disease (GERD) symptoms and medication use prior to undergoing study EGD. We compared BE cases separately to two control groups: 503 primary care controls and 1353 endoscopy controls. Associations between risk factors and differing BE case definitions were evaluated with multivariate logistic regression models.
For comparisons with primary care controls, early onset frequent GERD symptoms were more strongly associated with risk of long-segment BE (OR 19.9; 95% CI 7.96-49.7) than short-segment BE (OR 8.54; 95% CI 3.85-18.9). Likewise, the inverse association with H. pylori infection was stronger for long-segment BE (OR, 0.45; 95% CI, 0.26-0.79) than short-segment BE (OR, 0.71; 95% CI, 0.48-1.05). GERD symptoms and H. pylori infection was also more strongly associated with prevalent BE than newly diagnosed BE. Few differences were observed between BE cases and endoscopy controls. Endoscopy-only BE was associated with GERD symptoms (OR 2.25, 95% CI 1.32-3.85) and PPI/H2RA use (OR 4.44; 95% CI 2.61-7.54) but to a smaller degree than BE with SIM.
We found differences in the strength and profiles of risk factors for BE. The findings support that epidemiological studies of BE should make a distinction between long and short, new and prevalent, endoscopy-only and BE with SIM as well as type of controls.
既往关于巴雷特食管（BE）危险因素的研究病例定义和对照组各不相同。本研究的目的是探讨新诊断的BE与现患BE、长节段BE与短节段BE以及仅行内镜检查且无特殊肠化生（SIM）的BE之间危险因素的差异。
我们在一家退伍军人事务中心的基层医疗诊所招募了计划接受择期食管胃十二指肠镜检查（EGD）的符合条件患者以及符合结肠镜筛查条件的患者，进行了一项横断面研究。所有参与者在接受研究性EGD之前完成了一项关于人口统计学、胃食管反流病（GERD）症状和药物使用情况的调查。我们将BE病例分别与两个对照组进行比较：503名基层医疗对照和1353名内镜对照。采用多因素逻辑回归模型评估危险因素与不同BE病例定义之间的关联。
与基层医疗对照相比，早发性频繁GERD症状与长节段BE风险的关联（比值比[OR]19.9；95%置信区间[CI]7.96 - 49.7）比短节段BE（OR 8.54；95% CI 3.85 - 18.9）更强。同样，幽门螺杆菌感染与长节段BE的负相关（OR，0.45；95% CI，0.26 - 0.79）比短节段BE（OR，0.71；95% CI，0.48 - 1.05）更强。GERD症状和幽门螺杆菌感染与现患BE的关联也比新诊断的BE更强。BE病例与内镜对照之间观察到的差异较少。仅行内镜检查的BE与GERD症状（OR 2.25，95% CI 1.32 - 3.85）和质子泵抑制剂/组胺H2受体拮抗剂（PPI/H2RA）使用（OR 4.44；95% CI 2.61 - 7.54）相关，但程度小于伴有SIM的BE。
我们发现BE危险因素的强度和特征存在差异。这些发现支持BE的流行病学研究应区分长节段和短节段、新发病例和现患病例、仅行内镜检查的病例和伴有SIM的BE以及对照类型。
