Gastroenterology

Gastroenterology

Volume 121, Issue 6, December 2001, Pages 1286-1293
Gastroenterology

Clinical Science
Risk of adenocarcinomas of the esophagus and gastric cardia in patients with gastroesophageal reflux diseases and after antireflux surgery,☆☆

https://doi.org/10.1053/gast.2001.29569Get rights and content

Abstract

Background & Aims: Gastroesophageal reflux has been proposed as an important risk factor for esophageal and gastric cardia adenocarcinoma, but prospective data are lacking. Furthermore, the effect of antireflux surgery has not yet been studied. We conducted a population-based retrospective cohort study to fill these gaps. Methods: A cohort of 35,274 male and 31,691 female patients with a discharge diagnosis of gastroesophageal reflux diseases, and another cohort of 6406 male and 4671 female patients who underwent antireflux surgery, were identified in the Swedish Inpatient Register. Follow-up was attained through record linkage with several nationwide registers. Standardized incidence ratio (SIR) was used to estimate relative risk of upper gastrointestinal cancers, using the general Swedish population as reference. Results: After exclusion of the first year follow-up, 37 esophageal and 36 gastric cardia adenocarcinomas were observed among male patients who did not have surgery (SIR, 6.3, 95% confidence interval [CI], 4.5–8.7; SIR, 2.4, 95% CI, 1.7–3.3, respectively). SIR for esophageal adenocarcinoma increased with follow-up time (P = 0.03 for trend). Among male patients who had undergone antireflux surgeries, risks were also elevated (16 esophageal adenocarcinoma, SIR, 14.1, 95% CI, 8.0–22.8; 15 gastric cardia adenocarcinomas, SIR, 5.3, 95% CI, 3.0–8.7) and remained elevated with time after surgery. The cancer risk pattern in women was similar to that for men, but the number of cases were much smaller. Conclusions: Gastroesophageal reflux is strongly associated with the risk of esophageal adenocarcinoma, and to a lesser extent, with gastric cardia adenocarcinoma. The risk of developing adenocarcinomas of the esophagus and gastric cardia remains increased after antireflux surgery.

GASTROENTEROLOGY 2001;121:1286-1293

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.

    ☆☆

    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.

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