Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
BMJ. 2023 Sep 13;382:e076017. doi: 10.1136/bmj-2023-076017.
To assess the incidence rate of oesophageal adenocarcinoma among patients with non-erosive gastro-oesophageal reflux disease compared with the general population.
Population based cohort study.
All patients in hospital and specialised outpatient healthcare in Denmark, Finland, and Sweden from 1 January 1987 to 31 December 2019.
486 556 adults (>18 years) who underwent endoscopy were eligible for inclusion: 285 811 patients were included in the non-erosive gastro-oesophageal reflux disease cohort and 200 745 patients in the validation cohort with erosive gastro-oesophageal reflux disease.
Non-erosive gastro-oesophageal reflux disease was defined by an absence of oesophagitis and any other oesophageal diagnosis at endoscopy. Erosive gastro-oesophageal reflux disease was examined for comparison reasons and was defined by the presence of oesophagitis at endoscopy.
The incidence rate of oesophageal adenocarcinoma was assessed for up to 31 years of follow-up. Standardised incidence ratios with 95% confidence intervals were calculated by dividing the observed number of oesophageal adenocarcinomas in each of the gastro-oesophageal reflux disease cohorts by the expected number, derived from the general populations in Denmark, Finland, and Sweden of the corresponding age, sex, and calendar period.
Among 285 811 patients with non-erosive gastro-oesophageal reflux disease, 228 developed oesophageal adenocarcinomas during 2 081 051 person-years of follow-up. The incidence rate of oesophageal adenocarcinoma in patients with non-erosive gastro-oesophageal reflux disease was 11.0/100 000 person-years. The incidence was similar to that of the general population (standardised incidence ratio 1.04 (95% confidence interval 0.91 to 1.18)), and did not increase with longer follow-up (1.07 (0.65 to 1.65) for 15-31 years of follow-up). For validity reasons, we also analysed people with erosive oesophagitis at endoscopy (200 745 patients, 1 750 249 person-years, and 542 oesophageal adenocarcinomas, corresponding to an incidence rate of 31.0/100 000 person-years) showing an increased overall standardised incidence ratio of oesophageal adenocarcinoma (2.36 (2.17 to 2.57)), which became more pronounced with longer follow-up.
Patients with non-erosive gastro-oesophageal reflux disease seem to have a similar incidence of oesophageal adenocarcinoma as the general population. This finding suggests that endoscopically confirmed non-erosive gastro-oesophageal reflux disease does not require additional endoscopic monitoring for oesophageal adenocarcinoma.
评估非糜烂性胃食管反流病患者中食管腺癌的发病率与普通人群相比。
基于人群的队列研究。
丹麦、芬兰和瑞典所有医院和专门门诊医疗保健机构，时间为 1987 年 1 月 1 日至 2019 年 12 月 31 日。
486556 名年龄大于 18 岁的成年人接受内镜检查，符合纳入标准：285811 名患者纳入非糜烂性胃食管反流病队列，200745 名患者纳入糜烂性胃食管反流病验证队列。
非糜烂性胃食管反流病定义为内镜下无食管炎和任何其他食管诊断。糜烂性胃食管反流病为对比原因而检查，并定义为内镜下存在食管炎。
通过对每个胃食管反流病队列中观察到的食管腺癌病例数与丹麦、芬兰和瑞典相应年龄、性别和时间的普通人群的预期病例数进行比较，评估 31 年的随访中食管腺癌的发病率。采用标准化发病比及其 95%置信区间进行计算。
在 285811 名非糜烂性胃食管反流病患者中，228 名患者在 2081051 人年的随访中发展为食管腺癌。非糜烂性胃食管反流病患者的食管腺癌发病率为 11.0/100000 人年。发病率与普通人群相似（标准化发病比 1.04（95%置信区间 0.91 至 1.18）），且随着随访时间的延长而没有增加（15-31 年随访时为 1.07（0.65 至 1.65））。出于有效性原因，我们还分析了内镜下存在糜烂性食管炎的患者（200745 名患者，1750249 人年，542 例食管腺癌，发病率为 31.0/100000 人年），他们的总体食管腺癌标准化发病比呈升高趋势（2.36（2.17 至 2.57）），且随着随访时间的延长而更为显著。
非糜烂性胃食管反流病患者的食管腺癌发病率似乎与普通人群相似。这一发现表明，内镜证实的非糜烂性胃食管反流病不需要对食管腺癌进行额外的内镜监测。
