Epidemiologic Case-control Study of Barrett's Esophagus

该项目的长期目标是促进对Barrett食管的病理生理学和管理的理解，并为申请人提供流行病学和结果研究方面的进一步正式培训。申请人Shaheen博士是剑桥大学的助理教授，也是食管疾病中心的联合主任。他的导师Robert Sandler博士是一位公认的GI流行病学家，也是胃肠生物学和疾病中心（CGIBD）的主任。他们提出了一个结合教学和临床研究经验，利用公共卫生，GI部门和CGIBD的ESTA学校的资源，以促进博士沙欣的成果研究表现出的兴趣。来自杜克大学的道恩·普罗文泽尔博士也将提供指导和指导，以及巴雷特食管这一学科领域的专业知识。作为临床培训一部分提出的研究是Barrett食管的病例对照研究。巴雷特食管是食管腺癌的癌前病变，通常是致命的癌症，其发病率呈流行性增加。巴雷特氏症与胃食管反流有关。因为我们不能充分分层风险巴雷特之间的反流，当局建议所有那些慢性反流进行内镜筛查巴雷特。更好的巴雷特风险分层将允许更有针对性地使用筛查内镜。本研究的具体目的是：1）评估肥胖与Barrett's的关系; 2）评估H。pylori感染和Barrett's，3）评估Barrett's患者中发育不良的预测因素，4）评估Barrett's患者与反流对照组相比的生活质量。该研究将招募175例有反流症状和巴雷特食管的病例，以及350例有反流症状但无巴雷特食管的对照组，这些对照组在2010年接受内镜检查。参与者将完成一次电话访谈，评估人口统计学、健康习惯、早期H的风险因素。幽门获得和反流症状。此外，还将对受试者进行生活质量测量（健康状况问卷）和心理概况（修订的霍普金斯症状自评量表）。受试者将接受身高、体重、臀围和腰围评估。数据分析将比较体重和脂肪分布，以及早期H的风险因素。pylori获得，病例组和对照组之间。将Barrett's和发育不良的受试者与单独Barrett's的受试者进行比较，以评估发育不良的风险因素。最后，通过比较受试者与巴雷特的反流控制，并控制严重的反流，巴雷特的诊断对生活质量和心理压力的影响可以看出。

The long-term objectives of this project are to advance the understanding of the pathophysiology and management of Barrett's esophagus, and to achieve further formal training in epidemiology and outcomes research for the applicant. Dr. Shaheen, the applicant, is an Assistant Professor at UNC and is Co-Director of the Center for Esophageal Diseases. His mentor, Dr. Robert Sandler, is an established GI epidemiologist, and Director of the Center for Gastrointestinal Biology and Disease (CGIBD). They propose a combined didactic and clinical research experience, utilizing the resources of the UNC School of Public Health, the GI Division and the CGIBD to foster Dr. Shaheen's demonstrated interest in outcomes research. Dr. Dawn Provenzale from Duke University will also provide instruction and mentoring, as well as expertise in the subject area, Barrett's esophagus. The study proposed as part of the clinical training is a case-control study of Barrett's esophagus. Barrett's esophagus is a pre-malignant lesion of esophageal adenocarcinoma, a usually lethal cancer whose incidence is increasing in epidemic proportions. Barrett's is associated with gastroesophageal reflux. Because we cannot adequately stratify risk for Barrett's among those with reflux, authorities recommend that all those with chronic reflux undergo endoscopic screening for Barrett's. Better stratification of Barrett's risk would allow for more targeted usage of screening endoscopy. The specific aims of this study are: 1) To evaluate the relationship between obesity and Barrett's, 2) To assess the role of H. pylori infection and Barrett's, 3) To assess the predictors for dysplasia among those with Barrett's, and, 4) To assess the quality of life of those with Barrett's compared to controls with reflux. The study will recruit 175 cases with reflux symptoms and Barrett's esophagus, and 350 controls with reflux symptoms and no Barrett's who present for endoscopy at UNC. Participants will complete a telephone interview assessing demographics, health habits, risk factors for early H. pylori acquisition, and reflux symptoms. Also, subjects will be administered a measure of quality of life, the Health Status Questionnaire, and a psychological profile, the Revised Hopkins Symptom Checklist. Subjects will undergo assessment of height, weight, hip and waist circumference. Data analysis will compare body mass and fat distribution, as well as risk factors for early H. pylori acquisition, between cases and controls. Subjects with Barrett's and dysplasia will be compared to those with Barrett's alone to assess for risk factors for dysplasia. Finally, by comparing subjects with Barrett's to controls with reflux, and controlling for severs of reflux, the impact of a Barrett's diagnosis on quality of life and psychological stress may be seen.