超100万人数据:胃食管反流病患者应接受上消化道内镜检查
  • 纳入来自丹麦、芬兰、挪威和瑞典的1,062,740名新确诊GERD患者;
  • 平均随访7.0年期间,5324名发展出上消化道癌症,4465名死于上消化道癌症;
  • 与未进行上消化道内镜检查的患者相比,上消化道内镜检查阴性的GERD患者上消化道癌的发生率降低了55%(HR=0.45),死亡率降低了61%(HR=0.39);
  • 上消化道内镜检查阴性患者的上消化道癌症的发生及死亡风险分别在至少5年内及至少10年内均呈下降趋势。
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胃食管反流病(GERD)与上消化道癌症的风险增加相关。来自Gastroenterology上发表的一项前瞻性队列研究结果,在超过100万名北欧GERD患者中进行7年左右的随访,发现与未接受上消化道内镜检查的患者相比,上消化道内镜检查阴性的患者的上消化道癌症发生率及死亡率均显著降低。
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Gastroenterology [IF:22.682]

Incidence and mortality in upper gastrointestinal cancer after negative endoscopy for gastroesophageal reflux disease

内镜阴性的胃食管反流病患者的上消化道癌症的发病率和死亡率

10.1053/j.gastro.2021.10.003

2021-10-07, Article

Abstract & Authors:展开

Abstract:收起
Host-microbiota interactions in the esophagus during homeostasis and allergic inflammation: Gastroesophageal reflux disease (GERD) is associated with an increased risk of cancer of the upper gastrointestinal tract. This study aimed to assess whether and to what extent a negative upper endoscopy in patients with GERD is associated with a decreased incidence and mortality in upper gastrointestinal cancer (esophageal, gastric, or duodenal cancer).
Methods: Population-based cohort study of all patients with newly diagnosed GERD between July 1, 1979 and December 31, 2018 in Denmark, Finland, Norway, and Sweden. The exposure, negative upper endoscopy, was examined as a time-varying exposure, where participants contributed unexposed person-time from GERD diagnosis until screened and exposed person-time from the negative upper endoscopy. The incidence and mortality in upper gastrointestinal cancer were assessed using parametric flexible models, providing adjusted hazard ratios (HR) with 95% confidence intervals (CI).
Results: Among 1,062,740 patients with GERD (median age 58 years; 52% women) followed for mean 7.0 person-years, 5,324 (0.5%) developed upper gastrointestinal cancer and 4,465 (0.4%) died from such cancer. Patients who had undergone a negative upper endoscopy had 55% decreased risk of upper gastrointestinal cancer compared to those who did not undergo endoscopy (HR=0.45, 95% CI 0.43-0.48), a decrease which was more pronounced during more recent years (HR 0.34, 95% CI 0.30-0.38 from 2008 onwards), and was otherwise stable over sex and age groups. The corresponding reduction in upper gastrointestinal mortality among patients with upper endoscopy was 61% (adjusted HR=0.39, 95% CI 0.37-0.42). The risk reduction after a negative upper endoscopy in incidence and mortality lasted for five and at least ten years, respectively.
Conclusion: Negative upper endoscopy is associated with strong and long-lasting decreases in incidence and mortality in upper gastrointestinal cancer in patients with GERD.

First Authors:
Dag Holmberg

Correspondence Authors:
Jesper Lagergren

All Authors:
Dag Holmberg,Giola Santoni,My Catarina von Euler-Chelpin,Martti Färkkilä,Joonas H Kauppila,John Maret-Ouda,Eivind Ness-Jensen,Jesper Lagergren

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