Interactions among smoking, obesity, and symptoms of acid reflux in Barrett's esophagus
Interactions among smoking, obesity, and symptoms of acid reflux in Barrett's esophagus
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DOI：
10.1158/1055-9965.epi-05-0370
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发表时间：
2005-11-01
影响因子：
3.8
通讯作者：
Whiteman, DC
中科院分区：
文献类型：
--
作者：
Smith, KJ;O'Brien, SM;Whiteman, DC
背景：Barrett食管是食管腺癌的化生前体，在许多人群中越来越普遍。临床研究表明，酸反流导致巴雷特食管，但是，没有人口为基础的风险估计已被报道，和其他健康因素的作用，修改risk.Methods：我们进行了一项以人口为基础的病例对照研究，在澳大利亚布里斯班。病例为2003年2月至12月间确诊的167例经组织学证实的Barrett食管患者。从人口登记册中随机选择性别匹配和性别匹配的对照组（n = 261）。通过自我完成的问卷调查，然后通过电话访谈收集有关自我报告的胃酸反流、吸烟、肥胖和其他因素症状的数据。通过比值比（OR）和95%置信区间（95%CI）估计与这些暴露相关的Barrett食管和Barrett食管伴异型增生的风险，这些比值比（OR）和95%置信区间（95%CI）均为粗值，并经其他因素调整。（调整OR，29.7; 95% CI，12.2-72.6）和Barrett食管伴异型增生（OR，59.7; 95% CI，18.5-193）。吸烟也与巴雷特食管的风险有关。我们发现了反酸症状与吸烟和肥胖之间相互作用的证据。自我报告有酸反流症状的肥胖人群患巴雷特食管的风险（OR，34.4; 95%CI，6.3-188）明显高于单纯反流（OR，9.3; 95%CI，1.4-62.2）或单纯肥胖（OR，0.7，95%CI，0.2-2.4）的人群。同样，那些报告酸反流症状和吸烟的巴雷特食管（OR，51.4; 95%CI，14.1-188）比那些报告酸反流或吸烟单独的风险大大增加。结论：虽然历史上的酸反流的症状是与巴雷特食管的主要因素，肥胖和吸烟的风险大大增加。
Background: Barrett's esophagus, a metaplastic precursor to esophageal adenocarcinoma, is becoming increasingly prevalent in many populations. Clinical studies suggest acid reflux causes Barrett's esophagus; however, no population-based estimates of risk have been reported, and the role of other health factors in modifying risk is unclear.Methods: We conducted a population-based case-control study in Brisbane, Australia. Cases were 167 patients with histologically confirmed Barrett's esophagus diagnosed between February and December 2003. Age-matched and sex-matched controls (n = 261) were randomly selected from a population register. Data on exposure to self-reported symptoms of acid reflux, smoking, obesity, and other factors were collected through self-completed questionnaires followed by telephone interview. Risks of Barrett's esophagus and Barrett's esophagus with dysplasia associated with these exposures were estimated by the odds ratio (OR) and 95% confidence interval (95% Cl), both crude and adjusted for other factors.Results: Self-reported weekly episodes of acid reflux were associated with greatly increased risks of Barrett's esophagus (adjusted OR, 29.7; 95% CI, 12.2-72.6) and Barrett's esophagus with dysplasia (OR, 59.7; 95% CI, 18.5-193). Smoking was also associated with risk of Barrett's esophagus. We found evidence of interactions between symptoms of acid reflux and smoking and obesity. Obese people with self-reported symptoms of acid reflux had markedly higher risks of Barrett's esophagus (OR, 34.4; 95% CI, 6.3-188) than people with reflux alone (OR, 9.3; 95% CI, 1.4-62.2) or obesity alone (OR, 0.7,95% CI, 0.2-2.4). Similarly, those reporting both acid reflux symptoms and smoking were at substantially higher risks of Barrett's esophagus (OR, 51.4; 95% CI, 14.1-188) than those reporting acid reflux or smoking alone.Conclusions: Although history of symptoms of acid reflux is the principle factor associated with Barrett's esophagus, risks are substantially increased by obesity and smoking.