バレット 食道: レビュー
1University of Kansas School of Medicine, VA Medical Center, Kansas City, Kansas.
JAMA
|August 16, 2022
まとめ
バレット食道は,米国で5%に及ぶ疾患で,食道腺がんのリスクを高めます. 治療には,酸性抑制と監視と,不形成症や早期がんに対する内視鏡療法が含まれます.
科学分野:
- 胃腸内科と腫瘍科
- 食道疾患
- メタプラジアとがんの進行
背景:
- バレットの食道には,柱状転移による食道状細胞の置換が含まれています.
- 米国では5%で,世界では1%で,食道腺がんの生涯リスクは3~5%です.
- 危険因子 に は 年齢,男性 性,喫煙,胃食道 逆流 症 (GERD) が 含ま れ ます.
研究 の 目的:
- バレット食道の流行病学,危険因子,管理についてまとめます.
- メタプラシアからアデノカルシノーマへの進行を強調する
- 現在の治療と監視戦略について議論する.
主な方法:
- 疫学データと臨床観察の文献レビュー
- リスク要因と流行率の分析
- 現在の管理ガイドラインと治療結果の要約
主要な成果:
- バレット食道の罹患率は異なるが,高齢の男性と喫煙者ではより高い.
- 食道腺がんの年間進行率は0. 2% - 0. 5%です.
- エンドスコープによる治療は80~90%の患者に効果的です.
結論:
- アデノカルシノーマの危険性があるため,注意深い監視が必要です.
- 陽子ポンプ阻害剤はGERDを治療しますが,その化学予防作用は不明です.
- ランダム化試験は必要ですが,内視鏡による監視は推奨されます.
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