מתוך medicontext.co.il
NEW YORK (Reuters Health) – Surgery for gastroesophageal reflux disease (GERD) does not change the elevated risk of developing adenocarcinomas of the esophagus and gastric cardia associated with GERD.
In a study reported in the December issue of Gastroenterology, the Swedish Inpatient Register was used to collect data regarding patients hospitalized for heartburn, hiatal hernia, or esophagitis. The unoperated cohort included 66,965 patients. The researchers also evaluated outcomes for 11,077 individuals who underwent antireflux surgery.
The investigators, led by Dr. Weimin Ye, of Karolinska Institutet in Stockholm, excluded first-year observations. Follow-up ranged between 1 and 32 years.
Among the men, the incidence rate of esophageal adenocarcinoma in the unoperated cohort was 22.4 per 100,000 person-years, which translated to a standardized incidence ratio (SIR) of 6.3 compared with the general Swedish population. The relative risk increased significantly as follow-up lengthened. The SIR for gastric cardia adenocarcinoma among men was 2.4. Among women, corresponding SIRs were 6.1 and 2.3.
The risks of esophageal and gastric cardia adenocarcinoma were higher among men who underwent surgery, with the SIR increasing to 14.1 and 5.3. Supplementary vagotomy increased the risk still further.
In an editorial, Dr. Joel E. Richter, of the Cleveland Clinic Foundation in Ohio, notes that the many studies evaluating risk of cancer after antireflux surgery have shown conflicting results. Regarding surgical or medical therapy for GERD, he stresses the importance of informing patients of these uncertainties prior to treatment. "I believe patients can choose the regimen that best suits their individual needs," he concludes.
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