Age at onset of GERD symptoms predicts risk of Barrett's esophagus.
Age at onset of GERD symptoms predicts risk of Barrett's esophagus.
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DOI：
10.1038/ajg.2013.72
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发表时间：
2013-06
影响因子：
9.8
通讯作者：
El-Serag, Hashem B.
中科院分区：
文献类型：
--
作者：
Thrift, Aaron P.;Kramer, Jennifer R.;Qureshi, Zeeshan;Richardson, Peter A.;El-Serag, Hashem B.
胃食管反流病（GERD）的症状是巴雷特食管（BE）的主要危险因素。然而，症状发作时年龄的重要性尚不清楚。我们研究了GERD暴露的多个维度对BE风险的影响，以及这些相关性是否被BE的其他风险因素所改变。数据来自一项横断面研究，该研究纳入了683名在初级保健诊所接受择期食管胃内窥镜检查（EGD）或研究EGD同时接受结肠镜检查的退伍军人事务部患者。我们比较了236例内镜下疑似BE和组织学证实BE的患者与447例在研究EGD中没有内镜下疑似BE的初级保健患者（“初级保健对照”）。采用多变量logistic回归计算比值比（OR）和95%置信区间（CI）。发作时年龄<30岁的频繁（至少每周一次）GERD症状与BE的最高风险相关（OR = 15.1，95%CI 7.91-28.8），风险随症状发作时年龄的增加而线性增加（P趋势= 0.001）。这种关联与GERD症状的累积持续时间无关。报告曾使用质子泵抑制剂的早发GERD症状患者BE风险尤其高（OR = 31.1，95% CI 13.9-69.7）。在频繁出现GERD症状的人群中，幽门螺杆菌阳性患者的BE风险比H阴性患者低近80%（OR = 2.60，95%CI 1.26-5.40）。pylori感染者的OR值为8.24，95% CI为5.00-13.6。BE的风险随着频繁GERD症状发作时年龄的提前而线性增加。症状发作时的年龄可能有助于医生决定哪些有GERD症状的患者需要进行BE的内镜筛查。
Symptoms of gastroesophageal reflux disease (GERD) are the primary risk factor for Barrett’s esophagus (BE). However, the significance of age at symptom onset is unknown. We examined the effects of multiple dimensions of GERD exposure on BE risk and whether these associations are modified by other risk factors for BE. Data were from a cross-sectional study of 683 Veterans Affairs patients undergoing an elective esophagogastroduodenoscopy (EGD) or a study EGD concurrently with colonoscopy from primary care clinics. We compared 236 patients with both endoscopically suspected and histologically confirmed BE to 447 primary-care patients (“primary-care controls”) without endoscopically suspected BE on their study EGD. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression. Age at onset <30 years of frequent (at least weekly) GERD symptoms was associated with highest risk of BE (OR = 15.1, 95% CI 7.91–28.8), and risk increased linearly with earlier age at onset of symptoms (P-trend = 0.001). This association was independent of cumulative GERD symptom duration. People with early onset GERD symptoms who reported ever using proton pump inhibitors were at especially high risk of BE (OR = 31.1, 95% CI 13.9–69.7). In people with frequent GERD symptoms, BE risk was almost 80% lower among Helicobacter pylori-positive patients (OR = 2.60, 95% CI 1.26–5.40) than those negative for H. pylori (OR = 8.24, 95% CI 5.00–13.6). Risk of BE increased linearly with earlier age at onset of frequent GERD symptoms. Age at symptom onset may help practitioners decide which patients with GERD symptoms to refer for endoscopic screening for BE.
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