嚴重GERD症狀與食道癌呈反向關聯


  【24drs.com】根據發表於7月號外科學誌(Archives of Surgery)的橫斷面研究結果,接受治療的輕微或者無症狀胃食道逆流(GERD)患者的食道腺癌風險一般高於那些症狀嚴重者。
  
  匹茲堡大學胸腔與前腸外科的Katie S. Nason醫師等人寫道,食道腺癌篩檢聚焦在確認嚴重且持續GERD症狀之巴瑞特氏食道症病患;不幸的是,發生食道腺癌的病患有95%在癌症診斷前並不知道自己有巴瑞特氏食道,意味著他們並沒有被篩檢,一個可能的解釋是,GERD症狀的嚴重度與癌症風險之間並無關聯。
  
  這項研究驗證的假設是,嚴重GERD症狀和進行初步內視鏡篩檢之病患的巴瑞特氏食道、發育不良、癌症盛行率增加有關;一所大學附設的醫院中,769名GERD病患在2004年11月1日至2007年6月7日進行初步內視鏡篩檢,初級研究終點是食道腺瘤,定義為巴瑞特氏食道、發育不良或癌症,以及症狀嚴重度和使用質子幫浦抑制劑(PPI)治療。
  
  122名病患發現有食道腺癌,食道內視鏡檢查結果和嚴重GERD症狀數增加有正相關(勝算比[OR]為1.05;95%信心區間[CI]為1.01 - 1.09),相對的,嚴重GERD症狀數增加時,腺癌的勝算比較低(OR為0.94;95% CI為0.89 - 0.98)。
  
  服用PPI的病患中,相較於全部都是嚴重症狀者,無嚴重典型或非典型GERD症狀者分別有61.3%和81.5%更可能患有腺瘤。
  
  研究作者寫道,接受治療的輕微或無GERD症狀者,腺瘤的機率顯著高於接受治療的嚴重GERD症狀者;這個結果或許可以解釋目前根據症狀研究度制定的初步內視鏡檢查閾值為何會失敗。
  
  研究限制包括,屬於橫斷面研究、無法確認因果關係、未能控制所有已知的巴瑞特氏食道與食道腺瘤的風險因素、缺乏可確認症狀嚴重度的量表。
  
  研究作者結論表示,這些結果看來,除了建議長期且控制不佳的GERD病患進行巴瑞特氏食道症篩檢,那些長期但症狀控制不錯的典型或非典型GERD患者更需要加以篩檢。此外,因為嚴重非典型明顯症狀而於耳鼻喉科初診的病患,應優先考量進行初步內視鏡篩檢。大範圍的前瞻研究、最好有可信的嚴重度測量方式,將有助於我們確認依據症狀期間、抗分泌藥物之使用、目前的症狀嚴重度等分類巴瑞特氏食道等級,以獲得有關內視鏡篩檢的更有力指引。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6577&x_classno=0&x_chkdelpoint=Y
  

Severe GERD Symptoms Inversely Linked to Esophageal Cancer

By Laurie Barclay, MD
Medscape Medical News

July 21, 2011 — The risk for esophageal adenocarcinogenesis is significantly higher in medically treated patients with mild or absent symptoms of gastroesophageal reflux disease (GERD) vs those with severe symptoms, according to the results of a cross-sectional study reported in the July issue of the Archives of Surgery.

"Screening for esophageal adenocarcinoma has focused on identifying Barrett esophagus (BE) in patients with severe, longstanding symptoms of ...GERD," write Katie S. Nason, MD, MPH, from the Division of Thoracic and Foregut Surgery, University of Pittsburgh in Pittsburgh, Pennsylvania, and colleagues. "Unfortunately, 95% of patients who develop esophageal adenocarcinoma are unaware of the presence of BE before their cancer diagnosis, which means they never had been selected for screening. One possible explanation is that no correlation exists between the severity of GERD symptoms and cancer risk."

The hypothesis tested by this study was that severe GERD symptoms are not associated with an increased prevalence of BE, dysplasia, or cancer among patients undergoing primary endoscopic screening. At a university hospital, 769 patients with GERD underwent primary screening endoscopy from November 1, 2004, through June 7, 2007. The primary study endpoint was esophageal adenocarcinogenesis, defined as BE, dysplasia, or cancer, as a function of symptom severity and proton pump inhibitor (PPI) therapy.

Esophageal adenocarcinogenesis was detected in 122 patients. Endoscopic findings of esophagitis correlated positively with an increasing number of severe GERD symptoms (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01 - 1.09). In contrast, the odds of adenocarcinogenesis were lower with increasing number of severe GERD symptoms (OR, 0.94; 95% CI, 0.89 - 0.98).

Among patients taking PPIs, those with no severe typical or atypical GERD symptoms were 61.3% and 81.5% more likely to have adenocarcinogenesis, respectively, than patients who reported that all symptoms were severe.

"Medically treated patients with mild or absent GERD symptoms have significantly higher odds of adenocarcinogenesis compared with medically treated patients with severe GERD symptoms," the study authors write. "This finding may explain the failure of the current screening paradigm in which the threshold for primary endoscopic examination is based on symptom severity."

Limitations of this study include cross-sectional design, inability to determine causality, failure to control for all known risk factors for BE and esophageal adenocarcinoma, and lack of validation of the symptom severity scale developed for this study.

"These findings ... suggest that, rather than recommending BE screening only in patients with long-standing, poorly controlled GERD, patients with long-standing but well-controlled symptoms of typical or atypical GERD may be a better population to target," the study authors conclude. "In addition, patients who present initially to the otolaryngology clinic with severe atypical-predominate symptoms should be strongly considered for primary screening endoscopy. Larger-scale prospective studies, ideally having a validated measure of symptom severity, will enable us to determine the prevalence of BE stratified by symptom duration, antisecretory medication use, and current symptoms severity and lead to stronger guidance in recommendations for screening endoscopy."

The Robert Anthony McHugh Research Fund for the Prevention and Early Detection of Esophageal Cancer, American Surgical Association Foundation Fellowship Award, and the National Institutes of Health supported this study. The study authors have disclosed no relevant financial relationships.

    
相關報導
雙磷酸鹽類與食道癌:看似無關
2012/11/2 下午 03:31:53
Statins類藥物可能可以預防食道癌
2012/10/31 上午 10:40:03
Gefitinib為復發型食道癌帶來一線希望
2012/10/5 下午 01:39:54

上一頁
   1   2   3   4   5   6   7  




回上一頁