Bytzer P, Christensen P B, Damkier P, Vinding K, Seersholm N
The Department of Medical Gastroenterology S, Odense University Hospital, and Danish Cancer Society, Copenhagen.
Am J Gastroenterol. 1999 Jan;94(1):86-91. doi: 10.1111/j.1572-0241.1999.00776.x.
We described incidence rates of esophageal adenocarcinoma in Denmark in a 20-yr period and determined the proportion of patients diagnosed with esophageal adenocarcinoma who had a previous diagnosis of Barrett's esophagus, making them potential candidates for endoscopic surveillance.
Rates of esophageal and gastric cancers were collected from the Danish Cancer registry for the period 1970-1991. The registry was used to identify all cases of esophageal adenocarcinoma in the period 1987-1992. Medical records were retrieved and details concerning previous diagnosis of reflux disease and Barrett's esophagus were recorded.
The age- and gender-adjusted incidence of esophageal adenocarcinoma increased eightfold, from 0.3/10(5)/yr in 1970 to 2.3/10(5)/yr in 1990. This increase could not be explained by changes in classification or diagnostic routines. Medical data were retrieved for 524 of the 578 cases of esophageal adenocarcinoma reported during the period 1987-1992. A history of reflux symptoms or a diagnosis compatible with reflux was reported in 113 of 524 patients. A total of 119 patients (23%) had previously been investigated for dyspepsia or reflux symptoms, most often by endoscopy. A previous diagnosis of Barrett's esophagus was found in only 1.3% of the cancer patients.
The rate of esophageal adenocarcinoma in Denmark has increased eightfold over a 20-yr period, and this increase is not explained by changes in classification or diagnostic routines. More than 98% of esophageal adenocarcinomas were found in patients who could not have entered endoscopic surveillance, as Barrett's esophagus had not been diagnosed before the cancer diagnosis. Endoscopic surveillance to detect dysplasia may be an option for the individual patient with Barrett's esophagus, but these screening programs are not likely to reduce the death rate from esophageal adenocarcinomas in the general population.
我们描述了丹麦20年间食管腺癌的发病率，并确定了先前被诊断为巴雷特食管的食管腺癌患者的比例，这些患者是内镜监测的潜在对象。
收集丹麦癌症登记处1970 - 1991年期间食管癌和胃癌的发病率。该登记处用于识别1987 - 1992年期间所有食管腺癌病例。检索病历并记录有关先前反流性疾病和巴雷特食管诊断的详细信息。
年龄和性别调整后的食管腺癌发病率增加了八倍，从1970年的0.3/10⁵/年增至1990年的2.3/10⁵/年。这种增加无法用分类或诊断程序的变化来解释。在1987 - 1992年期间报告的578例食管腺癌病例中，检索到了524例的医学数据。524例患者中有113例报告有反流症状病史或与反流相符的诊断。共有119例患者（23%）先前因消化不良或反流症状接受过检查，最常见的检查方式是内镜检查。仅1.3%的癌症患者先前被诊断为巴雷特食管。
丹麦食管腺癌的发病率在20年期间增加了八倍，且这种增加无法用分类或诊断程序的变化来解释。超过98%的食管腺癌患者在癌症诊断前未被诊断出巴雷特食管，因此无法接受内镜监测。对于个别巴雷特食管患者，内镜监测以检测发育异常可能是一种选择，但这些筛查项目不太可能降低普通人群中食管腺癌的死亡率。
