Abstract:
OBJECTIVE:To accurately measure the incidence of gastric cancer among patients with gastric precancerous lesions, and to quantify the excess incidence in comparison with people with normal mucosa on endoscopy and a general population. DESIGN:Population based cohort study. SETTING:Population of Sweden using data from its national disease registers. PARTICIPANTS:405,172 patients who had gastric biopsy samples taken for non-malignant indications between 1979 and 2011. MAIN OUTCOME MEASURES:Incidence of gastric cancer, reported separately for patients with different mucosal changes in biopsy samples. Standardised incidence ratios provided estimation of the relative risk, using the general Swedish population as reference; and hazard ratios were derived from Cox regression modelling for internal comparisons with patients with normal gastric mucosa. RESULTS:After excluding the first two years of follow-up, 1599 cases of gastric cancer were identified. The annual crude incidence of gastric cancer was 20 × 10(-5) for those in the normal mucosa group (standardised incidence ratio 1.0), 42 × 10(-5) for those with minor changes (1.5), 59 × 10(-5) for the gastritis group (1.8), 100 × 10(-5) for the atrophic gastritis group (2.8), 129 × 10(-5) for the intestinal metaplasia group (3.4), and 263 × 10(-5) for the dysplasia group (6.5). Cox regression modelling confirmed that excess risks increased monotonically with progressive severity of gastric lesions, with the highest hazard ratio of 10.9 (dysplasia versus normal mucosa, 95% confidence interval 7.7 to 15.4). The increased incidence was stable throughout the follow-up period, and the gaps between cumulative incidence curves grew continuously. CONCLUSIONS:Among patients who undergo gastroscopy with biopsy for clinical indications, approximately 1 in 256 with normal mucosa, 1 in 85 with gastritis, 1 in 50 with atrophic gastritis, 1 in 39 with intestinal metaplasia, and 1 in 19 with dysplasia will develop gastric cancer within 20 years. These numbers, along with cost-benefit analyses, should guide future surveillance policies for these particular patient groups.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Song H,Ekheden IG,Zheng Z,Ericsson J,Nyrén O,Ye Wdoi
10.1136/bmj.h3867subject
Has Abstractpub_date
2015-07-27 00:00:00pages
h3867eissn
0959-8138issn
1756-1833journal_volume
351pub_type
杂志文章abstract:OBJECTIVE:To assess the effects of Helicobacter pylori treatment, vitamin supplementation, and garlic supplementation in the prevention of gastric cancer. DESIGN:Blinded randomized placebo controlled trial. SETTING:Linqu County, Shandong province, China. PARTICIPANTS:3365 residents of a high risk region for gastric ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
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更新日期:2019-09-11 00:00:00
abstract:OBJECTIVE:To evaluate the effects of a multifaceted empowerment strategy on the actual use of single embryo transfer after in vitro fertilisation. DESIGN:Randomised controlled trial. SETTING:Five in vitro fertilisation clinics in the Netherlands. PARTICIPANTS:308 couples (women aged <40) on the waiting list for a fi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2010-09-30 00:00:00
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更新日期:1989-01-07 00:00:00
abstract::Objective To estimate the incidence and prevalence of resistant hypertension among a UK population treated for hypertension from 1995 to 2015.Design Cohort study.Setting Electronic health records from the UK Clinical Practice Research Datalink in primary care.Participants 1 317 290 users of antihypertensive drugs with...
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pub_type: 杂志文章
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更新日期:2017-09-22 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.315.7099.50
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abstract:OBJECTIVE:To describe risk factors for infantile colic. DESIGN:Questionnaire administered by health visitors. SETTING:Sheffield. SUBJECTS:Mothers of 76,747 infants born between 1 August 1975 and 31 May 1988, interviewed when the infant was 1 month old. MAIN OUTCOME MEASURES:Reporting of infantile colic and its dura...
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doi:10.1136/bmj.314.7090.1325
更新日期:1997-05-03 00:00:00
abstract::A study was carried out analysing the operation of a drug rationalisation programme in a central London teaching district that had evolved from experience over 17 years. Creation of a limited list of about 700 drugs had been achieved by local consensus. Drug selection was based on appraisal of efficacy, safety, and co...
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pub_type: 杂志文章
doi:10.1136/bmj.297.6646.465
更新日期:1988-08-13 00:00:00
abstract:OBJECTIVE:To determine the effect of combinations of statins, aspirin, beta blockers, and angiotensin converting enzyme inhibitors in the secondary prevention of all cause mortality in patients with ischaemic heart disease. DESIGN:Open prospective cohort study with nested case-control analysis. SETTING:1.18 million p...
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pub_type: 杂志文章,多中心研究
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更新日期:2005-05-07 00:00:00
abstract:OBJECTIVE:To describe the mechanism established by Richmond, Twickenham, and Roehampton Health Authority to manage extracontractual referral requests made on behalf of its resident population and to examine its working in the first three months of the new arrangements. DESIGN:Description of the procedures for managing...
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doi:10.1136/bmj.303.6801.499
更新日期:1991-08-31 00:00:00
abstract::Since the World Health Organization (WHO) set a goal in 1988 of eradicating polio worldwide by 2000, the incidence of the disease has declined by 90% around the world, with national immunization days conducted in more than 120 countries. More than 450 million children were immunized in 1998 alone. Now, with only abo...
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更新日期:1999-03-20 00:00:00
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journal_title:BMJ (Clinical research ed.)
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更新日期:1989-11-25 00:00:00
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更新日期:1995-03-04 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1999-12-11 00:00:00
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更新日期:2001-05-12 00:00:00
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更新日期:2016-06-15 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2015-09-21 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c4990
更新日期:2010-10-06 00:00:00
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更新日期:1992-05-23 00:00:00
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更新日期:1992-12-12 00:00:00
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更新日期:1992-10-03 00:00:00
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更新日期:2017-02-08 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.39164.568183.AE
更新日期:2007-05-26 00:00:00
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pub_type: 杂志文章,meta分析
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更新日期:2002-09-07 00:00:00
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更新日期:2020-11-25 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2018-03-21 00:00:00
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更新日期:2008-03-15 00:00:00
abstract::An increase in the incidence of cardiovascular disease has generally been observed in postmenopausal women, but there have been few studies of the association between menopausal state and atherosclerosis. In this study 294 premenopausal and 319 postmenopausal women aged 45 to 55 were examined radiographically for calc...
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doi:10.1136/bmj.298.6674.642
更新日期:1989-03-11 00:00:00
abstract:OBJECTIVE:To assess the risk of epileptic seizures in people with and without epilepsy after vaccination with a monovalent AS03 adjuvanted pandemic A/H1N1 influenza vaccine (Pandemrix; Glaxo SmithKline, Sweden). DESIGN:Register based self controlled case series. SETTING:Three Swedish counties (source population 750,0...
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更新日期:2012-12-18 00:00:00