Gastroesophageal reflux symptoms in patients with adenocarcinoma of the esophagus or cardia
Gastroesophageal reflux symptoms in patients with adenocarcinoma of the esophagus or cardia
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DOI：
10.1002/cncr.22245
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发表时间：
2006-11-01
期刊：
影响因子：
6.2
通讯作者：
Falk, Gary
中科院分区：
文献类型：
--
作者：
Chak, Amitabh;Faulx, Ashley;Falk, Gary
背景在成人受试者中，内镜筛查胃灼热和反流的慢性胃食管反流症状的有效性取决于该策略在食管或贲门腺癌发生前检测受试者Barrett食管的灵敏度。本研究的目的是确定食管癌或贲门癌患者中有多大比例的患者在癌症诊断前根据先前反流性食管炎的存在和持续时间进行筛选内镜检查。所有在4家三级护理医院和2家退伍军人事务部（VA）医院接受内镜检查的食管腺癌、贲门腺癌或长段Barrett食管患者均接受了先前验证的问卷调查，以确定他们对常见胃食管反流病的回忆。375例受试者的研究人群主要包括294例（78%）白色男性。110例食管腺癌患者中只有67例（61%）和21例贲门腺癌患者中只有8例（38%）回忆起在诊断癌症前存在烧心或反流症状超过5年。110例患者中仅有40例（36%）为腺癌。21例贲门腺癌患者中有5例（24%）回忆起在癌症诊断前每周出现症状> 5年。在244例Barrett食管患者中，170例（70%）回忆胃灼热或反流> 5年，89例（37%）回忆每周症状> 5年。目前的实践，其使用在具有> 5年胃灼热或反流的患者中进行内窥镜检查的筛查策略，仅可以在处于发展食管腺癌或贲门腺癌的风险的那些患者中的有限比例中检测巴雷特上皮。
BACKGROUND. The efficacy of endoscopic screening for chronic gastroesophageal reflux symptoms of heartburn and regurgitation in adult subjects depends on the sensitivity of this strategy for detecting Barrett esophagus in subjects before the development of adenocarcinoma of the esophagus or cardia. The aim of the current study was to determine what proportion of patients with cancer of the esophagus or cardia would have been candidates for a screening endoscopy before their cancer diagnosis based on the presence and duration of preceding reflux symptoms.METHODS. All patients with adenocarcinoma of the esophagus, adenocarcinoma of the cardia, or long-segment Barrett esophagus presenting for endoscopy at 4 tertiary care and 2 Veterans Affairs (VA) hospitals were given a previously validated questionnaire to determine their recall of common gastroesophageal reflux symptoms.RESULTS. The study population of 375 subjects consisted primarily of 294 (78%) white men. Only 67 of 110 patients (61%) with adenocarcinoma of the esophagus and 8 of 21 patients (38%) with adenocarcinoma of the cardia recalled symptoms of heartburn or regurgitation being present for > 5 years before their diagnosis of cancer. Only 40 of 110 patients (36%) with adenocarcinoma. of the esophagus and 5 of 21 patients (24%) with adenocarcinoma of the cardia recalled weekly symptoms being present for > 5 years before their cancer diagnosis. Of the 244 patients with Barrett esophagus, 170 (70%) recalled heartburn or regurgitation for > 5 years and 89 patients (37%) recalled weekly symptoms for > 5 years.CONCLUSIONS. Current practice, which uses a screening strategy of performing endoscopy in patients with > 5 years of heartburn or regurgitation, can detect Barrett epithelium in only a limited proportion of those patients at risk for developing adenocarcinoma of the esophagus or adenocarcinoma of the cardia.