Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Digestion. 2022;103(6):411-420. doi: 10.1159/000526154. Epub 2022 Sep 8.
Helicobacter pylori eradication is expected to significantly change the prevalence of Barrett's esophagus (BE). However, few reports on this relationship exist. We analyzed the risk factors of BE using the current consensus on length of BE considering H. pylori infection status.
We analyzed 10,122 individuals (5,962 men; mean age = 52.9 ± 9.9 years) who had undergone esophagogastroduodenoscopy as part of a medical checkup. Correlations among factors including H. pylori infectious status, endoscopic findings, and BE ≥1 cm were analyzed.
Prevalence of BE, long-segment BE, and esophageal adenocarcinoma was 22.5%, 0.014%, and 0%, respectively. Logistic regression analysis showed that the risk factors for BE were hiatal hernia (odds ratio [OR]: 2.89 [2.59-3.24]), female sex (OR: 0.52 [0.46-0.59]), social drinking (OR:0.77 [0.68-0.87]), H. pylori eradication therapy (OR: 1.34 [1.19-1.51]), proton pump inhibitor (PPI) use (OR: 1.52 [1.18-1.96]), bile reflux (OR: 1.18 [1.04-1.33]), age ≥50 years (OR: 1.13 [1.02-1.26]), and nonsteroidal anti-inflammatory drug (NSAID) use (OR: 1.29 [1.02-1.62]). Although reflux esophagitis (RE) was more common in H. pylori-negative patients (17.2%) than in those after H. pylori eradication therapy (11.8%, p < 0.00001), the latter was correlated with BE, disputing RE as a strong risk factor for BE. Therefore, we conducted a subgroup analysis; most of the risk factors except for PPI use (p = 0.75), H2-receptor antagonist use (p = 0.078), and atrophic gastritis absence (p = 0.72) were positively correlated with BE after H. pylori eradication therapy compared with H. pylori-negative status.
H. pylori eradication, bile reflux, PPI use, and NSAID use were risk factors for BE along with hiatal hernia, male sex, and older age.
幽门螺杆菌（H. pylori）的根除预计会显著改变 Barrett 食管（BE）的流行情况。然而，关于这种关系的报道很少。我们根据当前关于 BE 长度的共识，分析了考虑 H. pylori 感染状态的 BE 的危险因素。
我们分析了 10122 名（5962 名男性；平均年龄 52.9±9.9 岁）作为体检一部分接受食管胃十二指肠镜检查的个体。分析了包括 H. pylori 感染状态、内镜检查结果和 BE≥1cm 在内的各种因素之间的相关性。
BE、长段 BE 和食管腺癌的患病率分别为 22.5%、0.014%和 0%。逻辑回归分析显示，BE 的危险因素包括食管裂孔疝（比值比 [OR]：2.89 [2.59-3.24]）、女性（OR：0.52 [0.46-0.59]）、社交性饮酒（OR：0.77 [0.68-0.87]）、H. pylori 根除治疗（OR：1.34 [1.19-1.51]）、质子泵抑制剂（PPI）使用（OR：1.52 [1.18-1.96]）、胆汁反流（OR：1.18 [1.04-1.33]）、年龄≥50 岁（OR：1.13 [1.02-1.26]）和非甾体抗炎药（NSAID）使用（OR：1.29 [1.02-1.62]）。尽管 H. pylori 阴性患者的反流性食管炎（RE）（17.2%）比 H. pylori 根除治疗后患者（11.8%，p<0.00001）更为常见，但后者与 BE 相关，这表明 RE 并不是 BE 的一个强烈危险因素。因此，我们进行了亚组分析；除了 PPI 使用（p=0.75）、H2 受体拮抗剂使用（p=0.078）和萎缩性胃炎缺失（p=0.72）之外，大多数危险因素在 H. pylori 根除治疗后与 H. pylori 阴性状态相比，与 BE 呈正相关。
H. pylori 根除、胆汁反流、PPI 使用和 NSAID 使用是 BE 的危险因素，此外还有食管裂孔疝、男性和年龄较大。
