Low Prevalence of Suspected Barrett's Esophagus in Patients With Gastroesophageal Reflux Disease Without Alarm Symptoms.
Low Prevalence of Suspected Barrett's Esophagus in Patients With Gastroesophageal Reflux Disease Without Alarm Symptoms.
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DOI：
10.1016/j.cgh.2018.08.066
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发表时间：
2019-04
期刊：
影响因子：
--
通讯作者：
Hur C
中科院分区：
文献类型：
--
作者：
Lin EC;Holub J;Lieberman D;Hur C
食管胃管镜检查（EGD）常用于评估胃食管反流病（GERD）而无报警症状，尽管其益处尚不清楚。我们的目的是确定作为EGD适应症的无并发症GERD的患病率、这些患者的人口统计学特征以及这些手术的内镜结局。我们从2003年至2014年在82个研究中心进行的543，103例EGD的大型国家数据库中收集了内窥镜检查数据。我们确定了没有报警症状（吞咽困难、出血、呕吐或体重减轻）的GERD患者。终点包括内镜下疑似Barrett食管（sBE）和疑似长段BE（sLSBE）（定义为≥ 3 cm）的患病率。我们发现，73，535例（13.5%）EGD用于GERD的主要适应症，无报警症状：仅4122例患者（5.6%）有sBE，其中24.2%有sLSBE。sBE和sLSBE的重要危险因素包括男性、年龄和白色人种。其他发现包括1337例患者（1.8%）的消化性溃疡和101例患者的疑似肿瘤（47例食管肿瘤，42例胃肿瘤，13例十二指肠肿瘤，2例其他肿瘤）。在一项对接受EGD的大型患者队列的分析中，无并发症GERD占EGD的近14%;在该人群中，仅23.6%为50岁以上的白色男性，其BE和食管腺癌风险增加。sBE的患病率低于以前的时代，并提出了关于EGD在无并发症GERD患者中检测Barrett食管的效用的问题。无并发症GERD的管理指南应考虑这些观察结果。
Esophagogastroduodenoscopy (EGD) is frequently used to evaluate gastroesophageal reflux disease (GERD) without alarm symptoms, although the benefits are not clear. We aimed determine the prevalence of uncomplicated GERD as an indication for EGD, the demographic characteristics of these patients, and the endoscopic outcomes of these procedures. We collected endoscopy data from a large national database of 543,103 EGDs performed at 82 sites from 2003 through 2014. We identified patients with GERD without alarm symptoms (dysphagia, bleeding, vomiting, or weight loss). Endpoints included the prevalence of endoscopically suspected Barrett’s esophagus (sBE) and suspected long-segment BE (sLSBE), defined as ≥ 3cm. We found that 73,535 EGDs (13.5%) were performed for a primary indication of GERD without alarm symptom: only 4122 patients (5.6%) had sBE, and of these, 24.2% had sLSBE. Significant risk factors for sBE and sLSBE included male sex, age, and white race. Other findings included peptic ulcers in 1337 patients (1.8%) and suspected tumors (47 esophageal, 42 gastric, 13 duodenal tumors, 2 other) in 101 patients. In an analysis of a large cohort of patients undergoing EGD, uncomplicated GERD accounted for almost 14% of EGDs; within this population, only 23.6% were white men older than 50 years, who have an increased risk of BE and esophageal adenocarcinoma. The prevalence of sBE is lower than in prior eras, and raises questions about the utility of EGDs to detect Barrett’s esophagus in patients with uncomplicated GERD. Guidelines for management of uncomplicated GERD should account for these observations.
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