中国食管癌高发地区功能性消化不良的流行病学和临床特征。
Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China.
机构信息
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China.
Department of Gastroenterology, Peking University Cancer Hospital and Institute, Beijing 100142, China.
出版信息
Chin Med J (Engl). 2021 Jun 4;134(12):1422-1430. doi: 10.1097/CM9.0000000000001584.
BACKGROUND
Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population.
METHODS
A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses.
RESULTS
A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028-4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251-0.741).
CONCLUSIONS
The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.
背景
功能性消化不良（FD）在食管鳞状细胞癌（ESCC）高发地区的研究较少。本研究旨在揭示该人群中 FD 和器质性消化不良（OD）的流行病学和临床特征。
方法
在中国一个 ESCC 高发地区进行了一项中老年人群为基础的研究。所有参与者均完成了胃食管反流病问卷和功能性胃肠病罗马 III 诊断问卷，并接受了胃镜检查。排除胃食管反流病后，未检查出的消化不良（UID）分为 OD 和 FD 进行进一步分析。
结果
2013 年 7 月至 2014 年 3 月期间，共纳入 2916 名参与者。我们通过问卷检测到 166 例 UID 病例，其中 17 例 OD 和 149 例 FD 通过胃镜诊断。OD 病例表现为反流性食管炎（RE）、ESCC 和十二指肠溃疡。烧心（52.94%）和反流（29.41%）在 OD 中常见，但 FD 和 OD 之间没有发现症状差异。男性、低教育水平和液体食物是 OD 的危险因素，而经常食用新鲜蔬菜是保护因素。FD 包括 56 例餐后不适综合征（PDS）（37.58%）、52 例上腹疼痛综合征（EPS）（34.89%）、9 例 PDS+EPS（6.04%）和 32 例 FD+功能性食管疾病（21.48%）。FD 患者的幽门螺杆菌感染率并不高于对照组（34.23%比 42.26%，P=0.240）。经常食用辛辣食物与 PDS 相关（比值比[OR]：2.088，95%置信区间[CI]：1.028-4.243），而饮用深井水对 PDS 有保护作用（OR：0.431，95%CI：0.251-0.741）。
结论
在所研究的人群中，FD 的患病率为 5.11%。对于仅通过罗马 III 问卷诊断为 UID 的患者，如果 ESCC 和 RE 可能被漏诊，应建议进行胃镜检查。
试验注册
ClinicalTrials.gov，NCT01688908；https://clinicaltrials.gov/ct2/show/record/NCT01688908。
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