■胆石症或胆囊切除术可能导致胃食管反流病(GERD)的发展,巴雷特食管(BE),和食管腺癌(EAC)通过胆汁反流;然而,目前的观察性研究得出的结果不一致。我们使用了一种结合荟萃分析和孟德尔随机化(MR)分析的新方法,评估他们之间的联系。
■使用PubMed进行文献检索,WebofScience,和Embase数据库,2023年11月3日评估胆石症或胆囊切除术之间相关性的观察性研究的荟萃分析,以及GERD的危险因素,BE,每个都进行了。此外,MR分析用于评估胆石症或胆囊切除术的遗传前倾向对这些食管疾病的致病影响.
■荟萃分析的结果表明,胆石症与BE发病率的升高风险显着相关(RR,1.77;95%CI,1.37-2.29;p<0.001),胆囊切除术是GERD的危险因素(RR,1.37;95CI,1.09-1.72;p=0.008)。我们观察到胆石症和GERD之间的显著遗传关联(OR,1.06;95%CI,1.02-1.10;p<0.001)和BE(OR,1.21;95%CI,1.11-1.32;p<0.001),以及胆囊切除术和GERD之间的相关性(OR,1.04;95%CI,1.02-1.06;p<0.001)和BE(OR,1.13;95%CI,1.06-1.19;p<0.001)。在对常见风险因素进行调整后,比如吸烟,酒精消费,和多变量分析中的BMI,GERD和BE的风险仍然存在。
■我们的研究表明,胆石症和胆囊切除术都会增加GERD和BE的风险。然而,没有观察到EAC风险的增加,尽管GERD和BE是导致EAC的主要病理生理途径。因此,胆石症和胆囊切除术患者应警惕食道症状;然而,侵入性EAC细胞学可能是不必要的。
UNASSIGNED: Cholelithiasis or cholecystectomy may contribute to the development of gastroesophageal reflux disease (GERD), Barrett\'s esophagus (BE), and esophageal adenocarcinoma (EAC) through bile reflux; however, current observational studies yield inconsistent findings. We utilized a novel approach combining meta-analysis and Mendelian randomization (MR) analysis, to assess the association between them.
UNASSIGNED: The literature search was done using PubMed, Web of Science, and Embase databases, up to 3 November 2023. A meta-analysis of observational studies assessing the correlations between cholelithiasis or cholecystectomy, and the risk factors for GERD, BE, and EACwas conducted. In addition, the MR analysis was employed to assess the causative impact of genetic pre-disposition for cholelithiasis or cholecystectomy on these esophageal diseases.
UNASSIGNED: The results of the meta-analysis indicated that cholelithiasis was significantly linked to an elevated risk in the incidence of BE (RR, 1.77; 95% CI, 1.37-2.29; p < 0.001) and cholecystectomy was a risk factor for GERD (RR, 1.37; 95%CI, 1.09-1.72; p = 0.008). We observed significant genetic associations between cholelithiasis and both GERD (OR, 1.06; 95% CI, 1.02-1.10; p < 0.001) and BE (OR, 1.21; 95% CI, 1.11-1.32; p < 0.001), and a correlation between cholecystectomy and both GERD (OR, 1.04; 95% CI, 1.02-1.06; p < 0.001) and BE (OR, 1.13; 95% CI, 1.06-1.19; p < 0.001). After adjusting for common risk factors, such as smoking, alcohol consumption, and BMI in multivariate analysis, the risk of GERD and BE still persisted.
UNASSIGNED: Our study revealed that both cholelithiasis and cholecystectomy elevate the risk of GERD and BE. However, there is no observed increase in the risk of EAC, despite GERD and BE being the primary pathophysiological pathways leading to EAC. Therefore, patients with cholelithiasis and cholecystectomy should be vigilant regarding esophageal symptoms; however, invasive EAC cytology may not be necessary.