The Prevalence of Barrett's Esophagus in Patients with *

巴雷特食管在以下患者中的患病率*

• 批准号: 6743029
• 负责人: BLAIR Anderson JOBE
• 金额: $ 7.55万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-01 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6743029
• 关键词: Barretts esophagus; adenocarcinoma; adolescence (12-20); adult human (21+); cancer risk; clinical research; endoscopy; esophagus neoplasm; gastrointestinal epithelium; gastrointestinal sign /symptom; human subject; laryngoscopy; metaplasia; questionnaires; reflux esophagitis

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.

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%，在就诊时，50% 的患者已处于晚期疾病，几乎没有治愈的机会。 Barrett化生引起的食管腺癌的预后很差：总体5年生存率低于10%。具有典型和慢性胃食管反流病 (GERD) 症状的患者需接受内窥镜筛查巴雷特化生。几项回顾性研究表明，通过常规内窥镜监测巴雷特食管发现的癌症患者的早期诊断和生存率显着改善。尽管做出了这些努力，大多数患食管腺癌的患者在癌症诊断之前并不知道巴雷特化生的存在。此外，这些患者中很大一部分从未报告过 GERD 症状。这些发现表明，大多数食管腺癌发展风险最高的患者从未接受过巴雷特化生筛查。一些研究人员认为，食管癌患者可能没有典型的胃食管反流病症状，因此不适合进行内镜筛查。结果，出现隐匿性疾病进展，并且在诊断时已出现晚期癌症。 已发表的大量数据支持复杂 GERD（食管炎和巴雷特化生）与食管外反流症状之间的因果关系。有孤立性食管外症状（即无胃灼热或反流）的患者中 GERD 相关食管损伤的患病率尚不清楚。 本研究的主要目的是确定转诊至耳鼻喉科诊所的有食管外反流症状的患者，其 Barrett 化生患病率与有 GERD 症状的人群相当。我们将比较有食管外反流症状的患者、有 GERD 症状和没有 GERD 症状的患者中经活检证实巴雷特化生的患病率。这两个对照组将通过俄勒冈健康与科学大学和波特兰退伍军人医疗中心的临床结果研究计划 (CORI) 内窥镜数据库前瞻性地累积。 这项试点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纳入标准。此外，这项研究将增进我们对食管外反流患者食管损伤自然史的了解，并提高对非 GERD 危险因素的认识。