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Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
N Engl J Med. 1999 Mar 18; 340(11):825-31.NEJM

Abstract

BACKGROUND

The causes of adenocarcinomas of the esophagus and gastric cardia are poorly understood. We conducted an epidemiologic investigation of the possible association between gastroesophageal reflux and these tumors.

METHODS

We performed a nationwide, population-based, case-control study in Sweden. Case ascertainment was rapid, and all cases were classified uniformly. Information on the subjects' history of gastroesophageal reflux was collected in personal interviews. The odds ratios were calculated by logistic regression, with multivariate adjustment for potentially confounding variables.

RESULTS

Of the patients interviewed, the 189 with esophageal adenocarcinoma and the 262 with adenocarcinoma of the cardia constituted 85 percent of the 529 patients in Sweden who were eligible for the study during the period from 1995 through 1997. For comparison, we interviewed 820 control subjects from the general population and 167 patients with esophageal squamous-cell carcinoma. Among persons with recurrent symptoms of reflux, as compared with persons without such symptoms, the odds ratios were 7.7 (95 percent confidence interval, 5.3 to 11.4) for esophageal adenocarcinoma and 2.0 (95 percent confidence interval, 1.4 to 2.9) for adenocarcinoma of the cardia. The more frequent, more severe, and longer-lasting the symptoms of reflux, the greater the risk. Among persons with long-standing and severe symptoms of reflux, the odds ratios were 43.5 (95 percent confidence interval, 18.3 to 103.5) for esophageal adenocarcinoma and 4.4 (95 percent confidence interval, 1.7 to 11.0) for adenocarcinoma of the cardia. The risk of esophageal squamous-cell carcinoma was not associated with reflux (odds ratio, 1.1; 95 percent confidence interval, 0.7 to 1.9).

CONCLUSIONS

There is a strong and probably causal relation between gastroesophageal reflux and esophageal adenocarcinoma. The relation between reflux and adenocarcinoma of the gastric cardia is relatively weak.

Authors+Show Affiliations

Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden. jesper.lagergren@mep.ki.seNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10080844

Citation

Lagergren, J, et al. "Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma." The New England Journal of Medicine, vol. 340, no. 11, 1999, pp. 825-31.
Lagergren J, Bergström R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340(11):825-31.
Lagergren, J., Bergström, R., Lindgren, A., & Nyrén, O. (1999). Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. The New England Journal of Medicine, 340(11), 825-31.
Lagergren J, et al. Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma. N Engl J Med. 1999 Mar 18;340(11):825-31. PubMed PMID: 10080844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. AU - Lagergren,J, AU - Bergström,R, AU - Lindgren,A, AU - Nyrén,O, PY - 1999/3/18/pubmed PY - 1999/3/18/medline PY - 1999/3/18/entrez SP - 825 EP - 31 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 340 IS - 11 N2 - BACKGROUND: The causes of adenocarcinomas of the esophagus and gastric cardia are poorly understood. We conducted an epidemiologic investigation of the possible association between gastroesophageal reflux and these tumors. METHODS: We performed a nationwide, population-based, case-control study in Sweden. Case ascertainment was rapid, and all cases were classified uniformly. Information on the subjects' history of gastroesophageal reflux was collected in personal interviews. The odds ratios were calculated by logistic regression, with multivariate adjustment for potentially confounding variables. RESULTS: Of the patients interviewed, the 189 with esophageal adenocarcinoma and the 262 with adenocarcinoma of the cardia constituted 85 percent of the 529 patients in Sweden who were eligible for the study during the period from 1995 through 1997. For comparison, we interviewed 820 control subjects from the general population and 167 patients with esophageal squamous-cell carcinoma. Among persons with recurrent symptoms of reflux, as compared with persons without such symptoms, the odds ratios were 7.7 (95 percent confidence interval, 5.3 to 11.4) for esophageal adenocarcinoma and 2.0 (95 percent confidence interval, 1.4 to 2.9) for adenocarcinoma of the cardia. The more frequent, more severe, and longer-lasting the symptoms of reflux, the greater the risk. Among persons with long-standing and severe symptoms of reflux, the odds ratios were 43.5 (95 percent confidence interval, 18.3 to 103.5) for esophageal adenocarcinoma and 4.4 (95 percent confidence interval, 1.7 to 11.0) for adenocarcinoma of the cardia. The risk of esophageal squamous-cell carcinoma was not associated with reflux (odds ratio, 1.1; 95 percent confidence interval, 0.7 to 1.9). CONCLUSIONS: There is a strong and probably causal relation between gastroesophageal reflux and esophageal adenocarcinoma. The relation between reflux and adenocarcinoma of the gastric cardia is relatively weak. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/10080844/Symptomatic_gastroesophageal_reflux_as_a_risk_factor_for_esophageal_adenocarcinoma_ L2 - http://www.nejm.org/doi/full/10.1056/NEJM199903183401101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -