Division of Gastroenterology, Portland VA Medical Center and Oregon Health & Science University, Portland, OR, USA.
Miraca Life Sciences, Irving, TX, USA.
Colorectal Dis. 2018 Sep;20(9):813-820. doi: 10.1111/codi.14114. Epub 2018 Apr 24.
Previous studies have found an increased risk for microscopic colitis (MC) associated with proton pump inhibitors. In patients with ulcerative colitis (UC) or Crohn's disease (CD), proton pump inhibitors have been associated with an increased risk for IBD flares and impaired outcomes. The aim of this study was to test the epidemiological associations between gastro-oesophageal reflux disease (GERD) and MC, UC or CD in a large database.
The Miraca Life Sciences Database is a national electronic repository of histopathological records of patients distributed throughout the entire USA. A case-control study evaluated whether the presence of Barrett's metaplasia, erosive oesophagitis on endoscopy or histological signs of reflux oesophagitis, clinical diagnosis of GERD or any GERD type affected the occurrence of MC, UC or CD among 228 506 subjects undergoing bidirectional endoscopy. Multivariate logistic regression analyses were used to calculate ORs and their 95% CI for the risk of MC, UC or CD associated with various types of GERD and were adjusted for age, sex and presence of Helicobacter pylori.
The analysis revealed an inverse relationship between GERD and different types of inflammatory bowel disease. The inverse relationships applied similarly to MC (mean = 0.62, 95% CI: 0.58-0.66), UC (mean = 0.89, 95% CI: 0.81-0.97) and CD (mean = 0.76, 95% CI: 0.69-0.85). It also applied to different forms of GERD, with a trend towards more pronounced inverse relationships associated with Barrett's metaplasia or erosive oesophagitis than clinical diagnosis of GERD.
Gastro-oesophageal reflux disease is inversely associated with all forms of inflammatory bowel disease, such as MC, UC, or CD.
先前的研究发现质子泵抑制剂与显微镜下结肠炎（MC）的风险增加有关。在溃疡性结肠炎（UC）或克罗恩病（CD）患者中，质子泵抑制剂与 IBD 发作风险增加和预后受损有关。本研究旨在通过大型数据库检验胃食管反流病（GERD）与 MC、UC 或 CD 之间的流行病学关联。
Miraca 生命科学数据库是一个全国性的电子存储库，其中包含分布在美国各地的患者的组织病理学记录。一项病例对照研究评估了巴雷特化生、内镜下糜烂性食管炎或反流性食管炎的组织学征象、GERD 的临床诊断或任何类型的 GERD 是否会影响 228506 名接受双向内镜检查的患者中 MC、UC 或 CD 的发生。多变量逻辑回归分析用于计算与各种类型的 GERD 相关的 MC、UC 或 CD 的 OR 及其 95%CI，并调整了年龄、性别和幽门螺杆菌的存在。
分析显示 GERD 与不同类型的炎症性肠病之间存在反比关系。这种反比关系同样适用于 MC（平均值=0.62，95%CI：0.58-0.66）、UC（平均值=0.89，95%CI：0.81-0.97）和 CD（平均值=0.76，95%CI：0.69-0.85）。它也适用于不同形式的 GERD，与 GERD 的临床诊断相比，巴雷特化生或糜烂性食管炎与更明显的反比关系相关。
胃食管反流病与所有形式的炎症性肠病（如 MC、UC 或 CD）呈反比关系。
