The Relation of Gastroesophageal Reflux Disease and Its Treatment to Adenocarcinomas of the Esophagus and Gastric Cardia

摘要: Objective. —To examine the relationship of gastrointestinal disorders and their treatment to risk adenocarcinomas esophagus gastric cardia (AEC). Design. —A medical record-based case-control study, with data collected on a standardized form by trained abstractor, blind status. Setting. large prepaid health plan. Subjects. —Case patients were plan members newly diagnosed histologically confirmed AEC from 1986 1992. For each 196 eligible case patients, one control was selected who matched for membership at time diagnosis, sex, year birth, duration membership. Main Outcome Measures. —Association between history gastroesophageal conditions treatment. Conditional logistic regression procedures used calculation odds ratios (ORs) corresponding 95% confidence intervals (CIs), adjustment race, smoking status, body mass index. Medications grouped into H 2 antagonists (cimetidine, ranitidine, famotidine, nizatidine) anticholinergics (propantheline bromide, dicyclomine hydrochloride, Donnatal [combination atropine sulfate, hyoscyamine phenobarbital, scopolamine hydrobromide], Librax chlordiazepoxide hydrochloride clidinium bromide]). Results. —Significant twofold or greater risks associated esophageal reflux, hiatal hernia, esophagitis/esophageal ulcer, difficulty swallowing. The ORs increased increasing number these conditions. Although fourfold linked four more prescriptions antagonists, reduced 1.5 (95% CI, 0.4 5.4) after adjusting predisposing Further analysis revealed that excess restricted persons reflux related No association observed overall use anticholinergics. However, conditions, decreased ( P trend=.08). Conclusions. —This study provides reassuring findings does not increase risk. It also quantifies elevated disease. research disease production premalignant epithelial changes may help elucidate carcinogenic mechanisms measures aimed early detection prevention AEC. JAMA . 1995;274:474-477)