| Abstrakt: |
This is a well-designed, population-based, case-control, epidemiological study to determine if individuals with symptoms of gastroesophageal reflux disease are at increased risk for the development of adenocarcinoma of the esophagus and gastric cardia. Over a 3-yr period, from 1994 to 1997, all newly diagnosed cases of adenocarcinoma of the esophagus and gastric cardia in Sweden were identified via a comprehensive countrywide network of contact individuals soon after diagnosis and before surgery. Cases were matched for age and sex with case controls. Of 618 eligible patients with adenocarcinoma of the esophagus or gastric cardia, 451 (85%) participated. At index esophagogastroduodenoscopy, biopsies were obtained at 2-cm intervals beginning at the cardia and extending proximally until normal squamous epithelium was reached. In addition, biopsies were taken of the tumor and surrounding tissue. A total of 424 of the patients underwent surgery, and 97% of biopsy and surgical specimens were reviewed by a single pathologist. All subjects and controls underwent an extensive interview where questions (range 161-553) were asked concerning the frequency, severity, and duration of heartburn symptoms as well as other potential confounding factors. The results of this study indicate that persons who experience symptoms of heartburn and regurgitation at least once a week are nearly 8 times (odds ratio = 7.7) more likely to develop esophageal adenocarcinoma than those without these symptoms. Furthermore, the risk was found to be "dose dependent" where those who had the most severe reflux symptoms were associated with the highest risk. Persons with particularly long-standing and frequent heart-burn symptoms were found to be 43 times more likely to develop esophageal adenocarcinoma than asymptomatic individuals. The authors emphasized that the heartburn-cancer association was independent of the presence of Barrett's esophagus. They based this statement on the fact that only 62% of those with esophageal adenocarcinoma had Barrett's tissue detected. Also of note, the risk of esophageal adenocarcinoma was 3 times higher among those who had used medications for symptomatic reflux compared to those who had not taken medications even after adjusting both groups for severity of symptoms. Reflux symptoms were also associated with a higher risk of adenocarcinoma of the gastric cardia though not nearly as strongly (odds ratio 2.0). As expected, squamous cell cancer was not associated with reflux symptoms (odds ratio 0.9). [ABSTRACT FROM AUTHOR] |
