Abstract:
BACKGROUND:The incidence of esophageal adenocarcinoma is increasing rapidly. Gastroesophageal reflux is a strong risk factor for this disease. The increase in incidence of esophageal adenocarcinoma coincided with the introduction of medications that promote reflux by relaxing the lower esophageal sphincter (LES), such as nitroglycerin, anticholinergics, beta-adrenergic agonists, aminophyllines, and benzodiazepines. OBJECTIVE:To test the possible association between use of LES-relaxing medications and risk for adenocarcinoma of the esophagus and gastric cardia. DESIGN:A nationwide population-based case-control study with in-person interviews. SETTING:Sweden, 1995 through 1997. PATIENTS:189 patients with newly diagnosed esophageal adenocarcinoma, 262 with adenocarcinoma of the gastric cardia, and 167 with esophageal squamous-cell carcinoma were compared with 820 population-based controls. MEASUREMENTS:Estimated incidence rate ratios, calculated by using multivariate logistic regression from case-control data with adjustment for potential confounding. RESULTS:Past use of LES-relaxing drugs was positively associated with risk for esophageal adenocarcinoma. Among daily, long-term users (>5 years) of LES-relaxing drugs, the estimated incidence rate ratio was 3.8 (95% CI, 2.2 to 6.4) compared with persons who had never used these drugs. Drugs of all classes contributed to the increased risk, but the association was particularly strong for anticholinergics. Short-term use of other types of LES-relaxing drugs did not seem to be strongly associated with risk. The association almost disappeared after adjustment for reflux symptoms, indicating that promotion of reflux is the link between use of LES-relaxing drugs and esophageal adenocarcinoma. If 15,490 men in any age group take LES-relaxing drugs daily for 5 years, 1 additional case of adenocarcinoma would be expected (number needed to treat for harm); in men older than 60 years of age, the number needed to treat for harm is 5,570. Assuming a causal relation, about 10% of the esophageal adenocarcinomas occurring in the population may be attributable to intake of LES-relaxing drugs. Cardia adenocarcinoma and esophageal squamous-cell carcinoma were not associated with use of LES-relaxing drugs. CONCLUSIONS:The widespread use of LES-relaxing drugs may have contributed to the increasing incidence of esophageal adenocarcinoma.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Lagergren J,Bergström R,Adami HO,Nyrén Odoi
10.7326/0003-4819-133-3-200008010-00007subject
Has Abstractpub_date
2000-08-01 00:00:00pages
165-75issue
3eissn
0003-4819issn
1539-3704pii
200008010-00007journal_volume
133pub_type
杂志文章abstract:BACKGROUND:Urine tests for Chlamydia trachomatis permit expansion of screening beyond traditional clinic environments. Prevention of infection in teenagers is a high priority. OBJECTIVE:To define the prevalence of C. trachomatis among teenagers by using the ligase chain reaction assay on urine specimens and to evaluat...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-127-9-199711010-00004
更新日期:1997-11-01 00:00:00
abstract::Two hundred forty previously healthy military personnel with nonstreptococcal upper respiratory infections were prospectively studied to define the incidence and clinicopathologic characteristics of possible virus-associated glomerulonephritis. Nine patients without preceding streptococcal infection had erythrocyte ca...
journal_title:Annals of internal medicine
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doi:10.7326/0003-4819-91-5-697
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abstract::Antimicrobial prophylaxis prevents recurrent urinary tract infections in susceptible women, but its cost effectiveness has not been studied. In a recent placebo-controlled trial of urinary prophylaxis, we also assessed cost effectiveness using a decision analysis model. In our hospital the direct cost of 1 patient yea...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
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abstract:Background:Cardiovascular implantable electronic devices (CIEDs) are associated with procedure-related complications, yet little is known about variation in complication rates among institutions that may suggest disparities in care quality. Objective:To assess institutional variation in risk-standardized complication ...
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journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-85-2-195
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abstract:OBJECTIVE:To assess safety, pharmacokinetics, and in-vivo virologic activity of five different combination regimens of zidovudine and didanosine compared with zidovudine alone in patients with human immunodeficiency virus type 1 (HIV-1) infection. DESIGN:Open-label, partially randomized, dose-ranging study. SETTING:U...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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abstract::Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-108-2-175
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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journal_title:Annals of internal medicine
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更新日期:2009-12-01 00:00:00
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
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更新日期:2003-07-15 00:00:00