Endoscopic screening for Barrett's esophagus as the major precursor lesion for esophageal adenocarcinoma is mostly offered to patients with symptoms of gastroesophageal reflux disease (GERD). However, other epidemiologic risk factors might affect the development of Barrett's esophagus and esophageal adenocarcinoma. Therefore, efforts to improve the efficiency of screening to find the Barrett's esophagus population "at risk" compared with the normal population are needed. In a cross-sectional analysis, we compared 587 patients with Barrett's esophagus from the multicenter German BarrettNET registry to 1976 healthy subjects from the population-based German KORA cohort, with and without GERD symptoms. Data on demographic and lifestyle factors, including age, gender, smoking, alcohol consumption, body mass index, physical activity, and symptoms were collected in a standardized epidemiologic survey. Increased age, male gender, smoking, heavy alcohol consumption, low physical activity, low health status, and GERD symptoms were significantly associated with Barrett's esophagus. Surprisingly, among patients stratified for GERD symptoms, these associations did not change. Demographic, lifestyle, and clinical factors as well as GERD symptoms were associated with Barrett's esophagus development in Germany, suggesting that a combination of risk factors could be useful in developing individualized screening efforts for patients with Barrett's esophagus and GERD in Germany.
SUMMARY
Risk stratification in patients with Barrett's esophagus (BE) to prevent the development of esophageal adenocarcinoma (EAC) is an unsolved task. The incidence of EAC and BE is increasing and patients are still at unknown risk. BarrettNET is an ongoing multicenter prospective cohort study initiated to identify and validate molecular and clinical biomarkers that allow a more personalized surveillance strategy for patients with BE. For BarrettNET participants are recruited in 20 study centers throughout Germany, to be followed for progression to dysplasia (low-grade dysplasia or high-grade dysplasia) or EAC for >10 years. The study instruments comprise self-administered epidemiological information (containing data on demographics, lifestyle factors, and health), as well as biological specimens, i.e., blood-based samples, esophageal tissue biopsies, and feces and saliva samples. In follow-up visits according to the individual surveillance plan of the participants, sample collection is repeated. The standardized collection and processing of the specimen guarantee the highest sample quality. Via a mobile accessible database, the documentation of inclusion, epidemiological data, and pathological disease status are recorded subsequently. Currently the BarrettNET registry includes 560 participants (23.1% women and 76.9% men, aged 22–92 years) with a median follow-up of 951 days. Both the design and the size of BarrettNET offer the advantage of answering research questions regarding potential causes of disease progression from BE to EAC. Here all the integrated methods and materials of BarrettNET are presented and reviewed to introduce this valuable German registry.
Zusammenfassung
Ziel der Studie Zur Verbesserung der gesundheitlichen Chancengleichheit
ist die Kommune ein zentrales Setting. Für eine bedarfsgerechte und
zielgruppenspezifische Umsetzung von Maßnahmen ist es wichtig, die
Herausforderungen und Bedarfe in den Kommunen zu verstehen. Dies gilt
v. a. für deprivierte Kommunen, die bislang kaum
Gesundheitsförderungsprogramme für Menschen in schwierigen
Lebenslagen anbieten. Die zentrale Forschungsfrage lautet: „Wie wird der
Handlungs- und Unterstützungsbedarf in Bezug auf die Umsetzung von
Maßnahmen der Prävention und Gesundheitsförderung mit
Fokus auf Menschen in schwierigen Lebenslagen in deprivierten Kommunen
wahrgenommen?“
Methodik Mittels leitfadengestützter
Expert/-innenbefragungen (n=10) wurden explorativ qualitative
Daten in fünf bayerischen Kommunen mit hohem Deprivationsgrad erhoben.
Den Grad stellt der Bayerische Index Multipler Deprivation (BIMD, 2010) dar, der
das Ausmaß des Ressourcenmangels auf Gemeindeebene zeigt. Die Daten
wurden mittels inhaltlich strukturierender Inhaltsanalyse nach Kuckartz
analysiert.
Ergebnisse Die entstandenen Hauptthemen der Analyse sind (1) wahrgenommene
Zielgruppen mit Unterstützungsbedarf, (2) Aktivposten für
Prävention und Gesundheitsförderung sowie (3) Handlungsbedarfe
in Bezug auf Prävention und Gesundheitsförderung. In den
befragten Kommunen in Bayern wurden Zielgruppen mit Unterstützungsbedarf
identifiziert. Gleichzeitig zeigte sich, dass in den meisten Kommunen wenige
Ressourcen und Strukturen zur Verfügung stehen, um sich der
Prävention und Gesundheitsförderung mit diesen Zielgruppen
anzunehmen.
Schlussfolgerung Die Studie zeigt, dass deprivierte Kommunen einen Bedarf
an bedarfs- und zielgruppengerechten Maßnahmen der Prävention
und Gesundheitsförderung für Menschen in schwierigen Lebenslagen
aufweisen. Diese Kommunen haben jedoch wenig Handlungsspielräume und
sollten daher gezielt, z. B. durch Vernetzungsarbeit,
unterstützt werden.
<p>Supplemental Table 1: Comparison of epidemiological risk factors in Barrett patients (n= 587) and population controls (n= 587) matched by gender and age</p>
<p>Supplemental Table 1: Comparison of epidemiological risk factors in Barrett patients (n= 587) and population controls (n= 587) matched by gender and age</p>
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