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每天喝一杯紅酒降低巴瑞特氏食道症風險

作者：Laurie Barclay, MD 

出處：WebMD醫學新聞

　　March 9, 2009 — 根據登載於3月Gastroenterology期刊的一個族群基礎案例控制研究結果，每天喝一杯紅酒可降低巴瑞特氏食道症(Barrett's esophagus)風險達56%。

　　資深作者、加州Kaiser Permanente的Douglas A. Corley醫師在新聞稿中表示，美國食道腺癌的比率激升，但是對其先兆疾病－巴瑞特氏食道症卻所知有限，我們試著釐清如何預防造成食道癌的病變。

　　本分析屬於評估巴瑞特氏食道症與腹部肥胖和食用抗氧化劑、蔬果之間關係大型研究的一部份；該研究顯示，每天食用八份蔬果以及維持正常體重，與降低巴瑞特氏食道症風險有關。

　　Corley醫師表示，我給嘗試預防巴瑞特氏食道症者的建議是，維持正持體重且遵守多食用蔬果與抗氧化劑的飲食；我們已經知道，紅酒對心臟有好處，因此，這裡所提的或許是健康生活習慣與每天一杯紅酒的額外好處。

　　研究樣本包括953名於2002至2005年間於北加州Kaiser Permanente招募的男性與女性，案例組(n = 320)是在最後兩年招募的病患，屬於國際疾病分類碼第9版(ICD-9)中巴瑞特氏食道症的新診斷患者，且由胃腸科醫師以內視鏡檢查確認。

　　控制組(n = 316)有ICD-9中的胃食道逆流症(GERD)，而其他控制組(n = 317)包括無此兩種狀況的其他人。

　　雖然總酒精攝取量與巴瑞特氏食道症的風險關聯不一致，適度飲酒者傾向有較低風險，重度飲酒者傾向有較高風險。校正人口統計學因素、身體質量指數(BMI)、抽菸、居住地之後，適度飲酒與巴瑞特氏食道症的風險有反轉關聯(勝算比[OR]為0.52)。

　　相較於未飲用紅酒者，每天飲用一杯以上紅酒或白酒者，巴瑞特氏食道症的風險降低達56%。

　　不過，飲用啤酒或烈酒者的巴瑞特氏食道症風險沒有降低；每天飲用一到兩杯者，紅酒對降低巴瑞特氏食道症風險的保護效果最大，飲用量增加並不會增加保護力。

　　研究限制包括屬於回溯設計。

　　雖然紅酒的保護機轉還不清楚，但研究者認為，紅酒中的抗氧化物質中和了GERD引起的氧化損傷；也許是紅酒飲用者一般會同時進食，而喝其他酒時不會進食，因而降低了酒精相關的食道組織損傷。

　　主要作者、Kaiser Permanente的流行病學家Ai Kubo醫師表示，但是我們無法排除飲用紅酒是其他尋求健康的行為的象徵。

　　同一期Gastroenterology期刊內的其他兩篇研究顯示，飲用紅酒與食道腺癌及食道炎風險較低有關。

　　Corley醫師表示，還不十分清楚治療胃酸逆流是否為預防巴瑞特氏食道症的必要項目；預防逆流的最佳方式是維持正常體重。

　　國家健康研究中心與Kaiser Permamente資助部份研究。

Drinking a Glass of Wine Daily Lowers the Risk for Barrett's Esophagus

By Laurie Barclay, MD

Medscape Medical News

March 9, 2009 — Drinking 1 glass of wine a day may lower the risk for Barrett's esophagus by 56%, according to the results of a population-based, case-control study reported in the March issue of Gastroenterology.

"The rate of esophageal adenocarcinoma in this country is skyrocketing yet very little is known about its precursor, Barrett's esophagus," senior author Douglas A. Corley, MD, from Kaiser Permanente in Oakland, California, said in a news release. "We are trying to figure out how to prevent changes that may lead to esophageal cancer."

This analysis was part of a larger study evaluating the association of Barrett's esophagus with abdominal obesity and consumption of dietary antioxidants, fruits, and vegetables. That study showed a lower risk for Barrett's esophagus linked to eating 8 servings of fruits and vegetables daily and maintaining a normal body weight.

"My advice to people trying to prevent Barrett's esophagus is: keep a normal body weight and follow a diet high in antioxidants and high in fruits and vegetables," Dr. Corley said. "We already knew that red wine was good for the heart, so perhaps here is another added benefit of a healthy lifestyle and a single glass of wine a day."

The study sample consisted of 953 men and women enrolled in Kaiser Permanente in Northern California between 2002 and 2005. Cases (n = 320) were patients enrolled for at least 2 years, with International Classification of Diseases, Ninth Revision (ICD-9), code for new diagnosis of Barrett's esophagus, and with endoscopy results reviewed by a gastroenterologist.

One control group (n = 316) had a diagnosis of gastroesophageal reflux disease (GERD) by ICD-9 code, and the other control group (n = 317) consisted of enrolled members without either condition.

Although total alcohol consumption was not consistently associated with the risk for Barrett's esophagus, there was a trend toward lower risk with moderate consumption and higher risk with heavy alcohol consumption. After adjustment for demographics, body mass index (BMI), smoking, and location, moderate drinking was inversely associated with the risk for Barrett's esophagus (odds ratio [OR], 0.52).

Compared with people who did not drink wine, those who reported consumption of 1 or more glasses of red or white wine daily had a 56% reduced risk for Barrett's esophagus.

However, people who drank beer or liquor had no lowering of risk for Barrett's esophagus. The protective effect of wine for lowering the risk for Barrett's esophagus was greatest with just 1 to 2?glasses daily, and it did not increase with greater consumption.

Limitations of this study include retrospective design.

Although the mechanism of the protective effect of wine is unclear, the investigators suggest that the antioxidants in wine may counteract the oxidative damage caused by GERD; or that wine drinkers typically consume food with their wine vs drinking alcohol without food, thereby reducing alcohol-related damage to esophageal tissue.

"But we cannot preclude the possibility that wine drinking is a proxy for other 'health-seeking' behavior," said lead author Ai Kubo, MD, an epidemiologist from Kaiser Permanente.

Two other studies reported in the same issue of Gastroenterology showed that wine drinking was associated with a lower risk for esophageal adenocarcinoma and esophagitis.

"It's not actually clear that treating the acid reflux will necessarily prevent getting someone from getting Barrett's esophagus," said Dr. Corley. "The best way to prevent reflux is to maintain a normal weight."

The National Institutes of Health and Kaiser Permamente funded this study in part.

Gastroenterology. 2009;136:806-815.

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