Clinical ScienceRisk of adenocarcinomas of the esophagus and gastric cardia in patients with gastroesophageal reflux diseases and after antireflux surgery☆,☆☆
Section snippets
Inpatient register
In 1964–1965, with computerization of discharge records for patients hospitalized in Sweden, the National Board of Health and Welfare established the Swedish Inpatient Register. In addition to the patients' national registration number (a unique identification number assigned to every resident in Sweden) up to 6 discharge diagnoses and 6 surgical procedures were included for each hospitalization. The 7th revision of the International Classification of Diseases (ICD-7) was used for coding
Patients with gastroesophageal reflux who did not undergo surgery
The cohort included 66,965 patients contributing a total of 376,622 person-years, from which 59,582 person-years accrued during the first year of follow-up were excluded. Demographic and other follow-up data stratified by sex are shown in Table 1.During the first year, we noted 28 cases of esophageal adenocarcinoma (SIR 28.8, 95% CI 19.1–41.6) and 63 cases of gastric cardia adenocarcinoma (SIR 24.3, 95% CI 18.7–31.1) among men, and these tumors were not considered in the subsequent analyses.
Discussion
Our prospective data further strengthen the supposition that the relationship between gastroesophageal reflux disease and esophageal adenocarcinoma is causal. Further support for a causal relationship comes from the higher relative risk of esophageal adenocarcinoma in patients with longer follow-up and in those with indications of more severe gastroesophageal reflux diseases. The moderate excess risk of squamous cell carcinoma of the esophagus in our gastroesophageal reflux patients is in
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Supported by grant 4279-B99-01XAB from the Swedish Cancer Society.
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Address requests for reprints to: Weimin Ye, M.D., M.Sc., Department of Medical Epidemiology, Karolinska Institutet, Box 281, SE171 77, Stockholm, Sweden. e-mail: [email protected]; fax: (46) 8-314975.