Epidemiologic Case-control Study of Barrett's Esophagus

该项目的长期目标是促进对Barrett‘s食道的病理生理学和管理的了解，并为申请者提供进一步的流行病学和结果研究方面的正式培训。申请者Shaheen博士是北卡罗来纳大学的助理教授，也是食道疾病中心的联席主任。他的导师罗伯特·桑德勒博士是一位著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。他们提出了一种教学和临床研究相结合的经验，利用北卡罗来纳大学公共卫生学院、胃肠科和CGIBD的资源来培养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，以及巴雷特食道这一主题领域的专业知识。作为临床培训的一部分，这项研究是巴雷特食道的病例对照研究。Barrett‘s食道是食管腺癌的癌前病变，食管腺癌是一种通常致命的癌症，其发病率正在以流行的比例增加。巴雷特病与胃食道反流有关。由于我们无法在有反流者中对Barrett‘s的风险进行充分的分层，当局建议所有慢性反流者接受Barrett’s的内窥镜筛查。对Barrett的风险进行更好的分层将允许更有针对性地使用筛查内窥镜。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之间的作用，3)评估Barrett‘s患者中不典型增生的预测因素，以及4)评估Barrett’s患者与有反流的对照组的生活质量。这项研究将招募175名有反流症状和Barrett‘s食道的患者，以及350名有反流症状但没有Barrett’s的对照组，他们在北卡罗来纳大学接受内窥镜检查。参与者将完成一次电话采访，评估人口统计学、健康习惯、早期感染幽门螺杆菌的风险因素和反流症状。此外，受试者将接受生活质量的测量，健康状况问卷，以及心理档案，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。数据分析将比较患者和对照组之间的体重和脂肪分布，以及早期感染幽门螺杆菌的风险因素。患有Barrett‘s和发育不良的受试者将与那些单独患有Barrett’s的受试者进行比较，以评估发育不良的风险因素。最后，通过将受试者与Barrett病的受试者与有反流的对照组进行比较，并控制反流的严重程度，可以看出Barrett的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.