Temporal trends of Barrett's oesophagus and gastro-oesophageal reflux and related oesophageal cancer over a 10-year period in England and Wales and associated proton pump inhibitor and H2RA prescriptions: a GPRD study.

INTRODUCTION

There is an increasing burden of gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus (BO), paralleled by an increasing incidence of oesophageal adenocarcinoma.

METHODS

Using the General Practice Research Database, we derived the incidence GORD and BO and incidence of oesophageal cancer (OC) populations, between 1996 and 2005. Acid suppression treatment over the study period was also studied.

RESULTS

There were 5860 patients with BO and 1 25 519 with GORD. The incidence of BO increased from 0.11 to 0.24/1000 men and from 0.06 to 0.11/1000 women. The incidence of GORD diagnosed in general practice remained stable. There were 69 incident OCs in patients with BOs and 183 incident OCs in patients with GORD occurring more than a year after the GORD diagnosis. The cumulative incidence of OC was 3.00/1000 BO patient years and 0.30/1000 GORD patient years. There was a progressive decrease in H2RA prescriptions from 39 to 14.5% and an increase in proton pump inhibitor prescriptions from 52 to 79% in patients with a new diagnosis of GORD.

CONCLUSION

The incidence of BO has doubled from 1996 to 2005, whereas the incidence of GORD has remained stable. OC occurred 10 times more commonly in patients with BO than those with GORD. Proton pump inhibitor prescribing increased gradually over the study period. These trends have significant implications for healthcare planning and financing in the UK and other countries.