摘要
Background and aims: While patients with Barrett s oesophagus develop oesophageal adenocarcinoma more fre quently than the general population, it has controversially been suggested that gastro-oesophageal reflux (GORD) itself is a more important determinant of risk. In order to assess the validity of this suggestion, we examined the risk of oesophageal cancer in patients with Barrett s and with GORD compared with the general population in a community based cohort study. Methods:Cohorts of patients with Barrett s (n = 1677), oesophagitis (n =6392), and simple reflux (n = 6328), and a reference cohort (n =13416)were selected from the General Practice Research Database.The last three cohortswere matched to the Barrett s cohort by general practitioner practice, age, and sex. Cox s regression analysis was used to calculate relative risks for oesophageal cancer. Standardised incidence ratio methodology was used to estimate the relative risks for oesophageal adenocarcinoma.Results: A total of 137 oesophageal cancers were identified,of which 94 prevalent cases were excluded. The hazard ratios for oesophageal cancer were 10.6 (5.1-22.0), 2.2 (0.9-5.2), and 1.7 (0.7-4.5) in the Barrett s, oesophagitis, and reflux cohorts compared with the reference cohort, respectively. The corresponding relative risks for oesophageal adenocarcinoma were 29.8 (9.6-106), 4.5 (1.04-19.6), and 3.1 (0.6-14.2). Conclusion:Barrett s oesophagus increases the risk of oesophageal cancer approximately 10 times and oesophageal adenocarcinoma approximately 30 times compared with the general population.There is only a modestly increased risk of oesophageal cancer in patients with reflux who have no record of Barrett s oesophagus.Our findings therefore do not support the suggestion that gastro-oesophageal reflux disease itself predisposes to cancer.
Background and aims: While patients with Barrett s oesophagus develop oesophageal adenocarcinoma more fre quently than the general population, it has controversially been suggested that gastro-oesophageal reflux (GORD) itself is a more important determinant of risk. In order to assess the validity of this suggestion, we examined the risk of oesophageal cancer in patients with Barrett s and with GORD compared with the general population in a community based cohort study. Methods:Cohorts of patients with Barrett s (n = 1677), oesophagitis (n =6392), and simple reflux (n = 6328), and a reference cohort (n =13416)were selected from the General Practice Research Database.The last three cohortswere matched to the Barrett s cohort by general practitioner practice, age, and sex. Cox s regression analysis was used to calculate relative risks for oesophageal cancer. Standardised incidence ratio methodology was used to estimate the relative risks for oesophageal adenocarcinoma.Results: A total of 137 oesophageal cancers were identified,of which 94 prevalent cases were excluded. The hazard ratios for oesophageal cancer were 10.6 (5.1-22.0), 2.2 (0.9-5.2), and 1.7 (0.7-4.5) in the Barrett s, oesophagitis, and reflux cohorts compared with the reference cohort, respectively. The corresponding relative risks for oesophageal adenocarcinoma were 29.8 (9.6-106), 4.5 (1.04-19.6), and 3.1 (0.6-14.2). Conclusion:Barrett s oesophagus increases the risk of oesophageal cancer approximately 10 times and oesophageal adenocarcinoma approximately 30 times compared with the general population.There is only a modestly increased risk of oesophageal cancer in patients with reflux who have no record of Barrett s oesophagus.Our findings therefore do not support the suggestion that gastro-oesophageal reflux disease itself predisposes to cancer.
