Relationship between time-varying status of reflux esophagitis and Helicobacter pylori and progression to long-segment Barrett’s esophagus: time-dependent Cox proportional-hazards analysis
Authors:
Open Access
- 15 August 2020
- journal article
- research article
- Published by Springer Nature in BMC Gastroenterology
- Vol. 20 (1) , 1-8
Abstract
Background: Reflux esophagitis (RE) and absence ofHelicobacter pylori(non-H. pylori) are considered to be associated with the progression to long-segment Barrett’s esophagus (LSBE). However, it is difficult to assess this association because RE andH. pyloristatus can change during follow-up. Additionally, the association betweenH. pylorieradication and LSBE remains unclear.Methods: A total of 11,493 asymptomatic Japanese subjects who underwent medical check-ups and were endoscopically diagnosed with short-segment Barrett’s esophagus (SSBE) between May 2006 and December 2015 were enrolled. The hazards of progression to LSBE were compared between time-varying RE andH. pyloriinfection/eradication by time-dependent multivariable Cox proportional hazards models.Results: A total of 7637 subjects who underwent additional medical check-ups after being diagnosed with endoscopic SSBE were analyzed. Subjects with RE and without current/pastH. pyloriinfection were strongly associated with a higher rate of progression to LSBE (adjusted hazard ratio [HR]: 7.17, 95% confidence interval [CI]: 2.48–20.73,p < 0.001 for RE and non-H. pylorivs. non-RE andH. pylorigroups). Subjects withH. pylorihad a lower rate of progression to LSBE (adjusted HR: 0.48, 95% CI: 0.22–1.07,p = 0.07 forH. pylorivs. non-H. pylori). Hazards of progression to LSBE were still lower in theH. pylorieradication group than that of the non-H. pylorigroup (adjusted HR: 0.51, 95% CI: 0.18–1.46,p = 0.21).Conclusions: RE and non-H. pyloriwere associated with the progression to LSBE, considering the changes in exposures.H. pyloriinfection was associated with the prevention of the development of LSBE irrespective of RE. The environment preventive of the development of LSBE persists for at least a few years afterH. pylorieradication.Keywords
All Related Versions
This publication has 40 references indexed in Scilit:
- The Table 2 Fallacy: Presenting and Interpreting Confounder and Modifier CoefficientsAmerican Journal of Epidemiology, 2013
- Investigation of the freely available easy-to-use software ‘EZR’ for medical statisticsBone Marrow Transplantation, 2012
- A substantial incidence of silent short segment endoscopically suspected esophageal metaplasia in an adult Japanese primary care practiceWorld Journal of Gastrointestinal Endoscopy, 2012
- DOES SHORT-SEGMENT COLUMNAR-LINED ESOPHAGUS ELONGATE DURING A MEAN FOLLOW-UP PERIOD OF 5.7 YEARS?Digestive Endoscopy, 2010
- Etiological difference between ultrashort- and short-segment Barrett’s esophagusJournal of Gastroenterology, 2010
- Current status of Barrett's esophagus research in AsiaJournal of Gastroenterology and Hepatology, 2010
- Interobserver reliability in the endoscopic diagnosis and grading of Barrett’s esophagus: an Asian multinational studyEndoscopy, 2010
- The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus: The Prague C & M CriteriaGastroenterology, 2006
- RETROSPECTIVE COHORT STUDY OF CHRONOLOGICAL CHANGE OF SHORT-SEGMENT BARRETT's ESOPHAGUSDigestive Endoscopy, 2004
- Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classificationGut, 1999