RSS Feeds
Update in Gastroenterology
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
This Update summarizes important developments published during the past year concerning clinical problems frequently encountered by practicing internists. New points are cited from several of the ongoing debates in the gastroenterology literature. The Update is divided into sections on the esophagus, acid peptic disease and Helicobacter pylori, gastrointestinal effects of cyclooxygenase-2 inhibitors, intestinal disease, cancer, and hepatobiliary disease. In addition, each section includes several “fast facts” to communicate briefly several newsworthy items.
Esophageal Disorders
Gastroesophageal Reflux Disease Was Associated with Increased Risk for Esophageal Cancer
-
Lagergren J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999; 340:825-31.
The incidence of adenocarcinoma of the esophagus and gastric cardia has increased sharply in the last decade. Because the reasons for this increase are unclear, researchers in Sweden conducted a nationwide case–control study to determine the epidemiologic association between gastroesophageal reflux and these tumors. One hundred eighty-nine patients with adenocarcinoma of the esophagus, 262 patients with adenocarcinoma of the cardia, 167 patients with squamous-cell carcinoma of the esophagus, and 820 controls were grouped according to symptoms of gastroesophageal reflux.
The odds of developing an esophageal adenocarcinoma was increased 7.7 times in people with recurrent reflux compared with controls (95% CI, 5.3 to 11.4). The incidence of adenocarcinoma of the gastric cardia also increased, but to a lesser extent (odds ratio, 2.0 [CI, 1.4 to 2.9]). In persons who had more frequent and long-lasting reflux, the likelihood of developing esophageal adenocarcinoma was increased 43-fold and the likelihood of developing adenocarcinoma of the cardia increased 4.4-fold.
This study showed the strong, probably causal, relationship between gastroesophageal reflux and adenocarcinoma of the esophagus. The relationship between reflux and adenocarcinoma of the cardia was …
