The Prevalence of Barrett's Esophagus in Patients with *

描述（由申请人提供）： 自1970年以来，由Barrett化生引起的食管腺癌的发病率增加了350%，在出现时，50%的患者将患有晚期疾病，几乎没有治愈的机会。Barrett化生引起的食管腺癌预后差：总的5年生存率低于10%。胃食管反流病（GERD）的典型和慢性症状的患者接受Barrett化生的内镜筛查。几项回顾性研究表明，通过常规内镜监测发现的巴雷特食管癌症患者的早期诊断和生存率显着提高。尽管有这些努力，大多数食管腺癌患者在癌症诊断前并不知道存在巴雷特化生。此外，这些患者中有很大一部分从未报告过GERD症状。这些发现表明，大多数食管腺癌发生风险最高的患者从未接受过Barrett化生筛查。一些研究者认为，食管癌患者可能没有典型的GERD症状，因此不能进行内镜筛查。因此，发生隐匿性疾病进展，并且在诊断时存在晚期癌症。 大量已发表的数据支持复杂性GERD（食管炎和Barrett化生）与食管外反流症状之间的因果关系。在有孤立性食管外症状的患者中GERD相关食管损伤的患病率（即，无胃灼热或反流）。 本研究的主要目的是确定有食管外反流症状的患者转诊至耳鼻喉科诊所，其Barrett化生的患病率与有GERD症状的人群相当。我们将比较食管外反流症状患者与有GERD症状和无GERD症状患者活检证实的Barrett化生的患病率。两个对照组将通过俄勒冈州健康与科学大学和波特兰VA医学中心的临床结局研究计划（科里）内窥镜数据库进行前瞻性累积。 这项初步研究将提供所需的数据，以改善食管腺癌的风险分层，并可能修改常规巴雷特筛查的入选标准。此外，这项研究将提高我们对食管外反流患者食管损伤自然史的理解，并提高对非GERD危险因素的认识。

DESCRIPTION (provided by applicant): The incidence of esophageal adenocarcinoma arising from Barrett's metaplasia has increased by 350% since 1970 and at the time of presentation, 50% of patients will have advanced disease with virtually no chance for cure. The prognosis for esophageal adenocarcinoma arising from Barrett's metaplasia is poor: The overall 5-year survival rate is less than 10%. Patients with classic and chronic symptoms of gastroesophageal reflux disease (GERD) undergo endoscopic screening for Barrett's metaplasia. Several retrospective studies have demonstrated an earlier stage of diagnosis and a marked improvement in survival of patients with cancers detected by routine endoscopic surveillance for Barrett's esophagus. In spite of these efforts, the majority of patients who develop esophageal adenocarcinoma are unaware of the presence of Barrett's metaplasia prior to cancer diagnosis. In addition, a large proportion of these patients have never reported symptoms of GERD. These findings suggest that the majority of patients who are at highest risk for the development of esophageal adenocarcinoma are never screened for Barrett's metaplasia. Some investigators have suggested that patients who develop esophageal cancer may not have typical GERD symptoms and therefore are not identified for endoscopic screening. As a result, occult disease progression occurs and advanced cancer is present at the time of diagnosis. Substantial published data support a causal relation between complicated GERD (esophagitis and Barrett's metaplasia) and extraesophageal reflux symptoms. The prevalence of GERD-related esophageal injury in patients with isolated extraesophageal symptoms (i.e., no heartburn or regurgitation) is unknown. The primary aim of this study is to establish that patients with symptoms of extraesophageal reflux who are referred to an otolaryngology clinic have a prevalence of Barrett's metaplasia equivalent to that of a population with GERD symptoms. We will compare the prevalence of biopsy proven Barrett's metaplasia in patients with extraesophageal reflux symptoms with patients who have GERD symptoms and those who do not have GERD symptoms. The two comparison groups will be prospectively accrued through the Clinical Outcomes Research Initiative (CORI) endoscopic database at Oregon Health and Science University and the Portland VA Medical Center. This pilot study will provide needed data to improve risk stratification for esophageal adenocarcinoma and potentially modify the inclusion criteria for routine Barrett's screening. In addition, this study will enhance our understanding of the natural history of esophageal injury in patients with extraesophageal reflux and raise awareness of non-GERD risk factors.