Department of gastroenterology and hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of gastroenterology and hepatology, The University of Kansas School of Medicine, Kansas City, KS, USA.
Dis Esophagus. 2021 May 22;34(5). doi: 10.1093/dote/doaa131.
Barrett's esophagus (BE), a premalignant condition for the development of esophageal adenocarcinoma (EAC), is a consequence of chronic gastroesophageal reflux disease (GERD). Although the incidence of EAC is increasing, a similar trend for BE is not clear. We aimed to evaluate the prevalence of newly diagnosed BE over time in a cohort of patients presenting with GERD symptoms. Information was prospectively collected between 1998 and 2015 for patients presenting to the endoscopy unit at a tertiary referral center for their index upper endoscopy for evaluation of GERD symptoms. Patients were asked to complete a validated GERD questionnaire that documents the onset of GERD symptoms (heartburn and acid regurgitation) and grades the frequency and severity of symptoms experienced. Demographic information, body mass index (BMI), and use of aspirin, nonsteroidal anti-inflammatory drugs, acid suppression therapy if any, smoking, family history, and endoscopic findings: erosive esophagitis, BE, and hiatal hernia were recorded. Patients evaluated during 1998-2003 (control) were compared with those presented in subsequent years (3-year cohorts) using chi-square test, and a multivariable logistic regression model was used to evaluate independent predictors. A total of 1109 patients were included in the analysis: mean age 56.9 years (standard deviation [SD] 12.8), 83% Caucasian, 93% male, and mean BMI 29.8 (SD 5.5). Overall, 226 (20.3%) patients were diagnosed with BE, with a mean BE length of 2.1 cm (SD 2.6). There was a significant decrease in the prevalence of BE over time from 24.3% in 1998-2003 to 13.5% in 2013-2015 (P = 0.002). During the same time period, a significant increasing trend in proton pump inhibitor (PPI) (41.7%; 1998-2003 vs. 80.2%; 2013-2015) (P < 0.001) and aspirin (ASA) use (23.7%; 1998-2003 vs. 25.9%; 2013-2015) (P = 0.034) was noted. There was also a significant reduction in cigarette smoking. In a multivariable logistic regression model for predicting the presence of newly diagnosed BE, there was a significant effect of timeframe even after adjusting for confounding variables. The results of our study indicate that there has been a steady and significant decline in the prevalence of BE in GERD patients over the last 2 decades. During this same time period, there has been an accompanying increase in the use of PPI, aspirin therapy, and a reduction in smoking, all modifiable risk factors potentially contributing to the decreasing prevalence of BE. Whether this decreasing prevalence of BE will lead to a reduction in EAC remains to be seen.
巴雷特食管（BE）是食管腺癌（EAC）发生的癌前病变，是慢性胃食管反流病（GERD）的后果。尽管 EAC 的发病率正在上升，但 BE 却没有出现类似的趋势。我们旨在评估在因 GERD 症状就诊的患者队列中，随时间推移新诊断出的 BE 的患病率。1998 年至 2015 年期间，在三级转诊中心的内镜单位为其 GERD 症状的索引上消化道内镜检查就诊的患者中，前瞻性地收集了信息。要求患者完成一份经过验证的 GERD 问卷，该问卷记录 GERD 症状（烧心和胃酸反流）的发作，并记录症状经历的频率和严重程度。记录了人口统计学信息、体重指数（BMI）、阿司匹林、非甾体抗炎药、任何酸抑制治疗的使用、吸烟、家族史和内镜检查结果：糜烂性食管炎、BE 和食管裂孔疝。使用卡方检验比较了 1998-2003 年（对照组）评估的患者与随后几年（3 年队列）评估的患者，并使用多变量逻辑回归模型评估了独立预测因子。共纳入 1109 例患者进行分析：平均年龄 56.9 岁（标准差 [SD] 12.8），83%为白种人，93%为男性，平均 BMI 为 29.8（SD 5.5）。总体而言，226 例（20.3%）患者被诊断为 BE，BE 平均长度为 2.1cm（SD 2.6）。BE 的患病率随时间呈显著下降趋势，从 1998-2003 年的 24.3%降至 2013-2015 年的 13.5%（P = 0.002）。在同一时期，质子泵抑制剂（PPI）（41.7%；1998-2003 年 vs. 80.2%；2013-2015 年）（P < 0.001）和阿司匹林（ASA）使用率（23.7%；1998-2003 年 vs. 25.9%；2013-2015 年）（P = 0.034）均呈显著上升趋势。吸烟也显著减少。在用于预测新诊断出的 BE 的多变量逻辑回归模型中，即使在调整了混杂变量后，时间框架仍具有显著影响。我们的研究结果表明，在过去的 20 年中，GERD 患者中 BE 的患病率一直在稳步显著下降。在此期间，PPI、阿司匹林治疗的应用有所增加，吸烟有所减少，所有这些可改变的危险因素都可能导致 BE 的患病率下降。BE 患病率的下降是否会导致 EAC 的减少还有待观察。
