Division of Gastroenterology, University of California, San Diego School of Medicine, ACTRI Building 1W517, 9500 Gilman Drive MC 0956, La Jolla, CA, 92093, USA.
Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Dig Dis Sci. 2020 Dec;65(12):3631-3638. doi: 10.1007/s10620-020-06098-5. Epub 2020 Feb 5.
The incidence of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) continues to rise, and risk stratification of patients with BE is needed. Impaired esophageal motility is associated with gastroesophageal reflux disease; however, whether esophageal dysmotility is a risk factor for dysplasia progression in BE is incompletely understood. This study aimed to characterize esophageal motility patterns in patients with BE and identify physiologic factors associated with dysplasia progression in BE.
This multicenter retrospective study assessed data from adult patients with histologically confirmed BE who underwent high-resolution esophageal manometry from 1/2014 to 1/2018 at four tertiary care centers. Longitudinal data were collected when available among patients with non-dysplastic BE (NDBE) and separated as: no dysplastic progression or positive dysplastic progression. Multivariable logistic regression assessed for independent predictors of dysplasia progression.
Among 193 patients, histology at index endoscopy identified 152 (79%) NDBE, 23 (12%) low-grade dysplasia, 14 (7%) high-grade dysplasia, and 4 (2%) EAC. Ninety-eight (51%) had abnormal esophageal motor function on manometry. Longitudinal data were available for 84 of 152 patients with initial NDBE. Twelve (14%) exhibited dysplastic progression to low-grade (6) or high-grade (6) dysplasia. Mean esophageal distal contractile integral was lower for patients that progressed [455 mmHg s cm (SD 515)] compared with patients who did not progress [987 mmHg s cm (SD 953); aOR 1.21 (95% CI 1.01, 1.44)].
In this retrospective study of 193 BE patients, the majority exhibited abnormal esophageal motor function. Reduced esophageal contractility was independently associated with dysplastic progression in BE. Characterizing esophageal physiology in BE may help to risk stratify patients.
巴雷特食管（BE）和食管腺癌（EAC）的发病率持续上升，因此需要对 BE 患者进行风险分层。食管运动功能障碍与胃食管反流病有关；然而，食管动力障碍是否是 BE 异型增生进展的危险因素尚不完全清楚。本研究旨在描述 BE 患者的食管运动模式，并确定与 BE 异型增生进展相关的生理因素。
这是一项多中心回顾性研究，纳入了 2014 年 1 月至 2018 年 1 月在四家三级护理中心接受高分辨率食管测压的经组织学证实的 BE 成年患者的数据。在无异型增生 BE（NDBE）患者中，当有纵向数据时，将其分为：无异型增生进展或异型增生阳性进展。多变量逻辑回归评估了异型增生进展的独立预测因素。
在 193 名患者中，索引内镜下的组织学检查发现 152 例（79%）为 NDBE、23 例（12%）为低级别异型增生、14 例（7%）为高级别异型增生和 4 例（2%）为 EAC。193 名患者中有 98 名（51%）在测压时存在食管运动功能异常。152 名初始 NDBE 患者中有 84 名有纵向数据。12 名（14%）患者进展为低级别（6 例）或高级别（6 例）异型增生。与未进展的患者[987mmHg·s·cm（SD 953）]相比，进展的患者[455mmHg·s·cm（SD 515）]的食管远端收缩积分较低[优势比（OR）1.21（95%置信区间 1.01，1.44）]。
在这项对 193 例 BE 患者的回顾性研究中，大多数患者存在异常的食管运动功能。食管收缩力降低与 BE 异型增生进展独立相关。对 BE 患者的食管生理进行特征分析可能有助于对患者进行风险分层。
