Lam S, Hart A R
Norfolk and Norwich University Hospital NHS Trust, Colney Lane.
Norwich Medical School, University of East Anglia, Norwich, UK.
Dis Esophagus. 2017 Nov 1;30(11):1-10. doi: 10.1093/dote/dox099.
Physical activity affects the functioning of the gastrointestinal system through both local and systemic effects and may play an important role in reducing the risk of esophageal adenocarcinoma. This review assesses the biological mechanisms and epidemiological evidence for the relationship between physical activity and the development of esophageal adenocarcinoma and its precursor diseases: gastroesophageal reflux disease (GORD) and Barrett's esophagus. A search of PubMed, Medline, Embase, and CINAHL was conducted from their inceptions to 25th March 2017 for analytical studies that examined associations between recreational and/or occupational levels of physical activity and the risk of GORD, Barrett's esophagus, and esophageal adenocarcinoma. Where appropriate, a meta-analysis of effects was undertaken. Seven studies were included (2 cohort, 5 case control). For GORD, there were three case-control studies with 10 200 cases among 78 034 participants, with a pooled estimated OR of 0.67 (95% CI 0.57-0.78) for high versus low levels of recreational physical activity. In Barrett's esophagus, there was a single case-control study, which reported no association, OR 1.19 (95% CI 0.82-1.73). For esophageal adenocarcinoma, there were three studies (two prospective cohort, one case control) with 666 cases among 910 376 participants. The largest cohort study reported an inverse association for high versus low levels of recreational physical activity, RR 0.68, 95% CI 0.48-0.96. The remaining two studies reported no associations with either occupational or combined recreational and occupational activity. Heterogeneity in the measurement of exposure (recreational, occupational, and both) made a pooled estimate for esophageal adenocarcinoma inappropriate. Although limited, there is some evidence that higher levels of recreational physical activity may reduce the risk of both GORD and esophageal adenocarcinoma, but further large cohort studies examining the type, intensity and duration of activities that may be beneficial are needed.
体力活动通过局部和全身效应影响胃肠系统的功能，可能在降低食管腺癌风险方面发挥重要作用。本综述评估了体力活动与食管腺癌及其前驱疾病：胃食管反流病（GORD）和巴雷特食管的发生之间关系的生物学机制和流行病学证据。检索了PubMed、Medline、Embase和CINAHL数据库，从建库至2017年3月25日，查找分析性研究，这些研究探讨了休闲和/或职业体力活动水平与GORD、巴雷特食管和食管腺癌风险之间的关联。在适当情况下，进行了效应的Meta分析。纳入了7项研究（2项队列研究，5项病例对照研究）。对于GORD，有3项病例对照研究，78034名参与者中有10200例病例，高水平与低水平休闲体力活动的合并估计比值比（OR）为0.67（95%可信区间[CI]0.57 - 0.78）。在巴雷特食管方面，有1项病例对照研究，报告无关联，OR为1.19（95%CI0.82 - 1.73）。对于食管腺癌，有3项研究（2项前瞻性队列研究，1项病例对照研究），910376名参与者中有666例病例。最大的队列研究报告高水平与低水平休闲体力活动呈负相关，风险比（RR）为0.68，95%CI0.48 - 0.96。其余2项研究报告职业体力活动或休闲与职业体力活动综合水平均无关联。暴露测量（休闲、职业及两者）的异质性使得对食管腺癌进行合并估计不合适。尽管证据有限，但有一些证据表明较高水平的休闲体力活动可能降低GORD和食管腺癌的风险，但需要进一步开展大型队列研究，以考察可能有益的活动类型、强度和持续时间。
