Epidemiologic Case-control Study of Barrett's Esophagus

该项目的长期目标是提高对Barrett食管病理生理学和治疗的认识，并为申请人提供进一步的流行病学和结果研究方面的正式培训。申请人Shaheen博士是UNC的助理教授，也是食道疾病中心的联合主任。他的导师罗伯特·桑德勒博士是一位知名的胃肠道流行病学家，也是胃肠道生物学和疾病中心（CGIBD）的主任。他们建议将教学和临床研究经验结合起来，利用北卡罗来纳大学公共卫生学院、GI部门和CGIBD的资源，培养Shaheen博士对结果研究的兴趣。杜克大学的Dawn Provenzale博士也将提供指导和指导，以及在巴雷特食管领域的专业知识。作为临床培训一部分的研究是Barrett食管的病例对照研究。巴雷特食管是食管腺癌的一种恶性前病变，通常是一种致命的癌症，其发病率呈流行病的比例增加。巴雷特氏病与胃食管反流有关因为我们不能在反流患者中对巴雷特氏病的风险进行充分的分层，权威人士建议所有慢性反流患者接受内窥镜检查巴雷特氏病。更好的巴雷特风险分层将允许更有针对性地使用筛查内窥镜检查。本研究的具体目的是：1)评估肥胖与Barrett's之间的关系，2)评估幽门螺杆菌感染和Barrett's的作用，3)评估Barrett's患者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名有反流症状和巴雷特食管的患者，以及350名在北卡罗来纳大学进行内窥镜检查的有反流症状但没有巴雷特食管的对照组。参与者将完成电话访谈，评估人口统计学、健康习惯、早期幽门螺旋杆菌感染的危险因素和反流症状。此外，受试者还将接受生活质量测量、健康状况问卷和心理概况、修订的霍普金斯症状检查表。受试者将接受身高、体重、臀围和腰围的评估。数据分析将比较病例和对照组之间的体重和脂肪分布，以及早期幽门螺杆菌感染的风险因素。将Barrett's和发育不良的受试者与单独患有Barrett's的受试者进行比较，以评估发育不良的危险因素。最后，通过将Barrett诊断与反流对照组进行比较，并控制反流的严重程度，可以看到Barrett诊断对生活质量和心理压力的影响。

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.