Background The causes of adenocarcinomas of the esophagus andgastric cardia are poorly understood. We conducted an epidemiologicinvestigation of the possible association between gastroesophagealreflux and these tumors.
Methods We performed a nationwide, population-based, case–controlstudy in Sweden. Case ascertainment was rapid, and all caseswere classified uniformly. Information on the subjects' historyof gastroesophageal reflux was collected in personal interviews.The odds ratios were calculated by logistic regression, withmultivariate adjustment for potentially confounding variables.
Results Of the patients interviewed, the 189 with esophagealadenocarcinoma and the 262 with adenocarcinoma of the cardiaconstituted 85 percent of the 529 patients in Sweden who wereeligible for the study during the period from 1995 through 1997.For comparison, we interviewed 820 control subjects from thegeneral population and 167 patients with esophageal squamous-cellcarcinoma. Among persons with recurrent symptoms of reflux,as compared with persons without such symptoms, the odds ratioswere 7.7 (95 percent confidence interval, 5.3 to 11.4) for esophagealadenocarcinoma and 2.0 (95 percent confidence interval, 1.4to 2.9) for adenocarcinoma of the cardia. The more frequent,more severe, and longer-lasting the symptoms of reflux, thegreater the risk. Among persons with long-standing and severesymptoms of reflux, the odds ratios were 43.5 (95 percent confidenceinterval, 18.3 to 103.5) for esophageal adenocarcinoma and 4.4(95 percent confidence interval, 1.7 to 11.0) for adenocarcinomaof the cardia. The risk of esophageal squamous-cell carcinomawas not associated with reflux (odds ratio, 1.1; 95 percentconfidence interval, 0.7 to 1.9).
Conclusions There is a strong and probably causal relation betweengastroesophageal reflux and esophageal adenocarcinoma. The relationbetween reflux and adenocarcinoma of the gastric cardia is relativelyweak.
Source Information
From the Department of Medical Epidemiology, Karolinska Institute, Stockholm (J.L., R.B., O.N.); the Department of Surgery, Karolinska Institute and Danderyd Hospital, Stockholm (J.L.); the Department of Statistics, Uppsala University, Uppsala (R.B.); and the Department of Pathology, Falu Hospital, Falun (A.L.) — all in Sweden.
Address reprint requests to Dr. Lagergren at the Department of Medical Epidemiology, Karolinska Institute, Box 281, S-171 77 Stockholm, Sweden, or at jesper.lagergren{at}mep.ki.se.
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