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Increased population prevalence of reflux and obesity in the United Kingdom compared with Sweden: A potential explanation for the difference in incidence of esophageal adenocarcinoma

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Abstract

The incidence of esophageal adenocarcinoma is five times higher in the UK than in Sweden. We examined the prevalence of established risk factors for esophageal adenocarcinoma in both populations. A population-based cross-sectional study comparing the prevalence of gastroesophageal reflux symptoms, obesity, and tobacco smoking between random samples of the English and Swedish populations aged 40-59 years. Data were collected through self-report questionnaires. Multivariable logistic regression yielded odds ratios with 95% confidence intervals, adjusting for potential confounding. The sample was composed of 3633 English and 1483 Swedish people (response rates 43 and 62%, respectively). The prevalence of reflux symptoms occurring at least weekly was twice as common in the English compared with the Swedish sample. Obesity (BMI ≥30) was also nearly two-fold more common in the English sample. The frequency of tobacco smoking was similar in both countries. The combination of reflux symptoms and a BMI of at least 25 was three-fold more common in the English than in the Swedish sample. The substantially higher prevalence of reflux symptoms and obesity in samples of the English population compared with the Swedish population might contribute to the known higher incidence of esophageal adenocarcinoma in the UK.

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... A review of the literature from 2000 shows that in Europe it varies from 8.8% to 27.5% [1,2,[10][11][12][13][14][15]. The largest report, provided by Mungan, included 8143 patients in a population-based cross-sectional study in Turkey. ...
... In the same year Lofdahl et al. presented an article based on 1483 samples, where the prevalence of GERD is the lowest among the cited papers. Heartburn or regurgitation appears in 8.8% of the Swedish population [14]. These discrepancies of estimated values result from many reasons. ...
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Introduction Gastroesophageal reflux disease (GERD), demonstrated to impair quality of life (QoL), appears to show significant variation in its prevalence. Estimation of the prevalence is difficult. When defined as at least weekly heartburn and/or acid regurgitation, the prevalence reported in Asia is 2.5–27.6%, in Europe 23.7% and in the US 28.8%. Aim The study evaluates the prevalence of GERD symptoms in the assessment of the GERD Impact Scale (GERD-IS) in two age groups of patients. Material and methods Evaluation of the prevalence of GERD symptoms with the GERD Impact Scale survey in two groups of patients: younger and older. A total of 2,649 surveys were rated. Statistical analysis was performed using the data analysis software system Statistica version 10.0 and Microsoft Excel. Results According to this study the symptoms of GERD included in GERD-IS in northern Poland vary from 0.9–2.4% as daily sensations to 18.9–40.5% occurring sometimes. Individuals with hiatal hernia (HH) were significantly older than those without HH. HH was significantly more frequent in males than females. Conclusions Estimation of the prevalence of GERD is difficult, because the medications are widely available and people use them without any consultation. They do not recognize the symptoms as a disease whose treatment can also be surgical. Our analysis shows that the prevalence of symptoms of GERD in northern Poland is as high as 5%. Hence further investigation should be performed and people’s awareness should be raised.
... Taken together, these studies strongly underline that AF patients do not exhibit the same risk factors for pathologies of the GI tract compared to a healthy population but rather represent a distinct cohort with an increased risk for incidental findings of the upper GI tract. Indeed, the proportion of clinically relevant incidental findings was higher amongst the AF patients in our cohort compared to published information on GI pathologies in the normal asymptomatic population without cardiac comorbidities 18 . In particular, overall relevant incidental findings such as reflux oesophagitis, mycosis-associated oesophagitis, erosive gastritis or duodenitis, gastral or duodenal ulcer and suspect mucosal and submucosal lesions were present in almost 75% of AF patients. ...
... This is in line with the findings of Knoop et al. 19 , who demonstrated that GI pathologies are frequently found in asymptomatic patients with cardiac disorders. Direct comparison of incidental findings though revealed that occurrence of reflux oesophagitis was distinctly higher in our study as compared to the findings of Knoop et al., who found an occurrence of reflux in 12%, which is comparable to the reflux rates observed for the normal population 18 . Nevertheless, other studies confirm our results of higher incidence of erosive oesophageal reflux disease in the AF population 14,20 . ...
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Pulmonary vein isolation (PVI) using cryoenergy is safe and efficient for treatment of atrial fibrillation (AF). Pre-existing upper gastrointestinal (GI) pathologies have been shown to increase the risk for AF. Therefore, this study aimed at assessing incidental pathologies of the upper GI tract in patients scheduled for PVI and to analyse the impact of patients’ characteristics on PVI safety outcome. In 71 AF patients, who participated in the MADE-PVI trial, oesophagogastroduodenoscopy and endosonography were prospectively performed directly before and the day after PVI to assess pre-existing upper GI pathologies and post-interventional occurrence of PVI-associated lesions. Subgroup analysis of the MADE-PVI trial identified clinically relevant incidental findings in 53 patients (74.6%) with age > 50 years being a significant risk factor. Pre-existing reflux oesophagitis increased risk for PVI-associated mediastinal oedema, while patients already treated with proton pump inhibitors (PPI) had significantly fewer mediastinal oedema. Our results suggest that AF patients with pre-existing reflux oesophagitis are at higher risk for PVI-associated mediastinal lesions, which is decreased in patients with constant PPI-treatment prior to PVI. Since PVI-associated mediastinal lesions are regarded as surrogate parameter for an increased risk of the fatal complication of an oesophago-atrial fistula, our findings hint at a beneficial effect of pre-interventional prophylactic PPI-treatment to reduce risk for PVI-associated complications. German Clinical Trials Register (DRKS00016006; date of registration: 17/12/2018).
... developed world in the last half century, positioning itself as the most dominant histological subtype of EC (3). There seem to be clear environmental influences, and predisposing factors (such as obesity, gastroesophageal reflux and Barrett's esophagus) also play an essential role in the natural history of EA (4)(5)(6). ...
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Background: Determining the best approach for esophageal cancer and predicting accurate prognosis are critical. Multiple studies evaluated characteristics associated with overall survival, and several prediction models have been developed. This study aimed to evaluate existing models and perform external validation of selected models. Methods: A retrospective investigation of a multi-site institutional enterprise for patients with a diagnosis of esophageal cancer between 2013-2014 was performed. Selected survival prediction models included the Roswell Park Comprehensive Cancer Center (RPCCC) calculator, Oregon Health & Science University (OHSU) calculator, and two nomograms published by Shapiro et al. and Sun et al. One-year overall survival, level of agreement, and performance for each model were evaluated. Results: A total of 104 patients were included and used to assess the prediction models. One-year overall survival was 0.76. Different calculators tended to rank patients similarly; however, they did not agree on predicted overall survival. The least disparity in correlation was observed between OHSU and Shapiro calculators. Shapiro's model achieved the highest performance [area under the curve (AUC) =0.63]. Conclusions: Selected models showed fair results in estimating individual overall survival, although none achieved a high performance. While these tools may support the decision-making process for esophageal cancer patients, their implementation in clinical practice requires improved refinement to optimize their clinical utility.
... The appearance of gastroesophageal reflux disease in 12% n = 51 of our study population is within the range surveyed in other European countries. 15 Although this was not the main focus of our study, we cannot find a higher incidence of erosive gastroesophageal reflux disease in our AF population, as suggested by previous studies. 16,17 (13) .77 ...
Article
Although rare, atrioesophageal fistula is a serious and often lethal complication of radiofrequency catheter ablation in patients with atrial fibrillation (AF). Consequently, esophagogastroduodenoscopy (EGD) after AF catheter ablation has been suggested to detect thermal esophageal lesions. To report the incidence of thermal lesions and other incidental gastrointestinal (GI) pathologies in AF patients after radiofrequency catheter ablation. 425 (mean age 59±10 years, 64 % male) consecutive patients with symptomatic AF who underwent left atrial radiofrequency catheter ablation were scheduled for upper GI endoscopy 1 - 3 days after the procedure. Patients were asymptomatic for gastrointestinal diseases, i.e. exhibiting no dysphagia, heart burn, or abdominal pain. Pathological gastrointestinal findings were observed in 328 patients (77%) and included: gastral erosions (22 %), esophageal erythema (21 %), gastroparesis (17 %), hiatal hernia (16 %), reflux esophagitis (12 %), thermal esophageal lesion (11 %) and suspected Barrett's esophagus (5 %). Biopsies were extracted in 70 patients, showing gastritis (84 %), Helicobacter pylori colonization (17 %) and mucosa-associated lymphoid tissue (17 %), esophagitis (9%), and Barrett's esophagus (4%). Further diagnostic work-up or treatment was initiated in 105 (25%) patients. Upper GI pathologies are frequently observed in asymptomatic patients. Half of all patients have a requirement for treatment. Among the findings, thermal esophageal lesions and gastroparesis can be attributed to AF catheter ablation. The high incidence of gastroparesis is a novel finding that deserves further investigation.
... Obesity In addition to predisposing to diabetes and cardiovascular disease, a number of epidemiological studies over the past several decades have demonstrated that overweight and obese individuals have increased incidence of multiple different types of cancers (Finucane et al., 2011). Obesity and elevated visceral fat increase the incidence of gastroesophageal reflux disease (GERD) and Barrett's esophagus, which are risk factors for esophageal cancer (Lö fdahl et al., 2011). The incidence of colonic adenomas and carcinomas correlates with increased body mass index (Calle and Kaaks, 2004;Ma et al., 2013;Okabayashi et al., 2012). ...
Article
Organismal diet has a profound impact on tissue homeostasis and health in mammals. Adult stem cells are a keystone of tissue homeostasis that alters tissue composition by balancing self-renewal and differentiation divisions. Because somatic stem cells may respond to shifts in organismal physiology to orchestrate tissue remodeling and some cancers are understood to arise from transformed stem cells, there is a likely possibility that organismal diet, stem cell function, and cancer initiation are interconnected. Here we will explore the emerging effects of diet on nutrient-sensing pathways active in mammalian tissue stem cells and their relevance to normal and cancerous growth.
... Gastroesophageal reflux disease (GERD) symptoms, including heartburn and regurgitation, are among the most common gastrointestinal (GI) symptoms in Europe and the United States, with prevalence rates of 10%-25% in population-based studies. [1][2][3][4][5] In 2009, GERD was the most common physician diagnosis for GI disorders in outpatient clinic visits in the United States and responsible for 8.9 million physician visits. 6 Reports from many other populations have shown a high prevalence of GERD or an increase in the prevalence in recent years. ...
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BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease (GERD) and mortality at the general population level and they have shown mixed results. This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran. METHODS Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study (GCS). We identified 3107 deaths (including 1146 circulatory and 470 cancer-related) with an average follow-up of 6.4 years and calculated hazard ratios (HR) and 95% confidence intervals (CI) adjusted for multiple potential confounders. RESULTS Severe daily symptoms (defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants) were associated with cancer mortality (HR 1.48, 95% CI: 1.04-2.05). This increase was too small to noticeably affect overall mortality. Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms. CONCLUSION We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality.
... A United States report showed that there has been a parallel five-or six-fold rise in adenocarcinoma [17] . A rising incidence of adenocarcinoma has also been reported from Canada [18] , the United Kingdom [19] , Australia [20] and the Netherlands [21] . Pohl et al [22] asked whether we are reaching a peak of adenocarcinoma incidence? ...
Article
Aim: To investigate the clinical epidemiological characteristics of gastric cancer in the Hehuang valley, China, to provide a reference for treatment and prevention of regional gastric cancer. Methods: Between February 2003 and February 2013, the records of 2419 patients with gastric cancer were included in this study. The patient's characteristics, histological and pathological features, as well as the dietary habits of the patients, were investigated. Results: The clinical data showed that adenocarcinoma was the leading histological type of gastric cancer in this area. Characteristics of gastric cancer in different ethnic groups and age showed that the 60.55-65.50 years group showed the high incidence of gastric cancer in all ethnic groups. There were more male gastric cancer patients than female. Intestinal was the most common type of gastric cancer in the Hehuang valley. There was no significant difference in the proportion of sex in terms of Helicobacter pylori infection. The impact of dietary habits on gastric cancer showed that regular consumption of fried or grilled food, consumption of high-salt, high-fat and spicy food and drinking strong Boiled brick-tea were three important factors associated with gastric cancer in males and females. Conclusion: Differences existed in race, sex, and age of patients according to the epidemiology of gastric cancer in the Hehuang valley. Moreover, dietary habits was also an important factor contributing to gastric cancer.
... The high prevalence of both obesity and GORD in combination could contribute increasing incidence of OAC in many areas of the developed world. Sweden, where there are lower rates of obesity and GORD, has a lower incidence of OAC [Lofdahl et al. 2011]. The association between obesity and OAC is stronger in younger participants [Chow et al. 1998]. ...
Article
The incidence of oesophageal adenocarcinoma has increased dramatically in the developed world in the last half century. Over approximately the same period there has been an increase in the prevalence of obesity. Multiple epidemiological studies and meta-analyses have confirmed that obesity, especially abdominal, visceral obesity, is a risk factor for gastro-oesophageal reflux, Barrett's oesophagus and oesophageal adenocarcinoma. Although visceral obesity enhances gastro-oesophageal reflux, the available data also show that visceral obesity increases the risk of Barrett's oesophagus and adenocarcinoma via reflux-independent mechanisms. Several possible mechanisms could link obesity with the risk of oesophageal adenocarcinoma in addition to mechanical effects increasing reflux. These include reduced gastric Helicobacter pylori infection, altered intestinal microbiome, factors related to lifestyle, the metabolic syndrome and associated low-grade inflammation induced by obesity and the secretion of mediators by adipocytes which may directly influence the oesophageal epithelium. Of these adipocyte-derived mediators, increased leptin levels have been independently associated with progression to oesophageal adenocarcinoma and in laboratory studies leptin enhances malignant behaviours in cell lines. Adiponectin is also secreted by adipocytes and levels decline with obesity: decreased serum adiponectin levels are associated with malignant progression in Barrett's oesophagus and experimentally adiponectin exerts anticancer effects in Barrett's cell lines and inhibits growth factor signalling. At present there are no proven chemopreventative interventions that may reduce the incidence of obesity-associated oesophageal cancer: observational studies suggest that the combined use of a statin and aspirin or another cyclo-oxygenase inhibitor is associated with a significantly reduced cancer incidence in patients with Barrett's oesophagus.
... Most patients who fail PPI treatment have Non Erosive Reflux Disease and without pathological reflux on pH testing. In patients with persistent heartburn despite of medical therapy, it is reasonable to recommend avoidance of specific lifestyle activities that have been identified by patients or physicians to trigger GERD-related symptoms [36][37][38] . ...
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Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m(2)) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m(2) and those with BMI > 35 kg/m(2) with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.
... United States, with similar increases observed in other high income European countries (Cook et al, 2009;Kroep et al, 2014). Reasons for this increase in incidence are poorly defined; however, obesity is a major risk factor for this malignancy (Kong et al, 2011;Lofdahl et al, 2011;Hoyo et al, 2012;Kubo et al, 2013). Studies of adult anthropometry-typically captured within the period of 10 years before diagnosis in middle age-have shown strong positive associations between body mass index (BMI)/visceral adiposity and oesophageal adenocarcinogenesis (Hoyo et al, 2012;Kubo et al, 2013), with gastroesophageal reflux (Pandolfino et al, 2006;Derakhshan et al, 2011) and dysfunctional metabolic effects (Reid et al, 2010;Ryan et al, 2011) being primary candidates for underlying causal mechanisms. ...
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Background: Middle-aged obese adults are at substantially elevated risk of oesophageal adenocarcinoma. It is unclear whether this risk originates earlier in life. Methods: We assessed associations between childhood body mass index (BMI) and height-measured annually between ages 7 and 13-with adult oesophageal adenocarcinoma in a cohort from the Copenhagen School Health Records Register. Analyses included 255 053 children born during 1930-1971. Danish Cancer Registry linkage provided outcomes. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression. Results: During 5.4 million person-years of follow-up, 254 (216 males) incident oesophageal adenocarcinomas occurred. At each examined age, cancer risk increased linearly per unit BMI z-score, although associations were only statistically significant for ages 9-13. The HR for the age of 13 years was 1.31 (95% CI: 1.13, 1.51) per unit BMI z-score. Associations were similar in men and women and across birth cohorts. Childhood height was not related to cancer risk in men but was in women, although these analyses included just 38 female cases. HRs per unit height z-score at the age of 13 years were 1.04 (0.90, 1.19) in males and 1.77 (1.27, 2.47) in females, with similar results observed at the other examined ages. Conclusion: Individuals with higher childhood BMI were at elevated risk of oesophageal adenocarcinoma, even though these cancers occurred many decades later in life. Although the mechanisms require further investigation, our findings provide additional evidence for the long-term health risks of childhood obesity.
... In 2008, there were 482 300 new cases, and 406 800 patients succumbed to their disease [1]. Squamous cell carcinoma (SCC) has been the predominating histology in the past century, but the incidence of adenocarcinoma (AC) of the esophagus and the gastro-esophageal junction is rising in developed countries [2], most likely due to a shift in risk factors [3]. ...
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The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.
... The higher prevalence of reflux symptoms and obesity in UK population compared with Swedish population is the possible explanation for the higher ADC incidence in the United Kingdom. 21 In Rio Grande do Sul State, a populational study reported the prevalence rate of 48% for GERD symptoms, 22 and another study determined the prevalence rate of 2.5% for Barrett's esophagus in people submitted to endoscopy examination for GERD symptoms. 23 Therefore, in southern Brazil, there is a high prevalence of GERD and on contrary that is expected there is a low prevalence of Barrett's esophagus. ...
Article
Squamous cell carcinoma (SCC) and adenocarcinoma (ADC) are the two main histological types of esophageal cancer. Southern Brazil has the highest rates of esophageal cancer in South America, and the most prevalent subtype of esophageal cancer has been SCC. This study assessed the trend changes in the histological types of esophageal cancer, in a 20-year period, in the central region of Rio Grande do Sul State, Brazil. We searched all cases of esophageal cancer from 1993 to 2012 by their histological diagnosis, grouping the patients in 4-year time periods to evaluate time trends. Among 18 441 upper gastrointestinal endoscopies we identified 686 cases of esophageal cancer. Histological study confirmed the diagnosis of SCC in 640 (93.3%) patients and ADC in 46 (6.7%). Overall, 522 men were diagnosed with esophageal carcinoma; from these, 489 (93.6%) presented SCC, and 33 (6.3%) ADC. Among women, 164 had the diagnosis of esophageal cancer, 151 (92%) SCC, and 13 (7.9%) ADC. The proportion found among men and women was 3.1:1, respectively. The prevalence rate of esophageal cancer, along a 20 year-period, remained stable, as well as the rates of SCC and ADC. SCC was the most common type of esophageal cancer, and ADC presented very low prevalence. © 2015 International Society for Diseases of the Esophagus.
... There is an increasing prevalence of esophageal cancer in particular adenocarcinoma of the distal esophagus being reported in Western populations and more recently in Asia [34,35]. This has been thought to be related to increasing obesity, gastroesophageal reflux disease, and a declining prevalence of H. pylori infection [36,37]. The role and evidence for H. pylori involvement in the etiology of esophageal cancer remain controversial. ...
Article
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Helicobacter pylori (H. pylori) infection is etiologically associated with gastric cancer and peptic ulcer diseases which are both important public health burdens which could be largely eliminated by H. pylori eradication. However, some investigators urge caution based on the hypothesis that eradication of H. pylori may result in an increase in the incidence of gastroesophageal reflux disease, esophageal adenocarcinoma, and childhood asthma. The ethnic Malays of northeastern Peninsular Malaysia have long had a low prevalence of H. pylori infection and, as expected, the incidence of gastric cancer and its precursor lesions is exceptionally low. The availability of a population with a low H. pylori prevalence and generally poor sanitation allows separation of H. pylori from the hygiene hypothesis and direct testing of whether absence of H. pylori is associated with untoward consequence. Contrary to predictions, in Malays, erosive esophagitis, Barrett's esophagus, distal esophageal cancers, and childhood asthma are all of low incidence. This suggests that H. pylori is not protective rather the presence of H. pylori infection is likely a surrogate for poor hygiene and not an important source of antigens involved in the hygiene hypothesis. Helicobacter pylori in Malays is related to transmission from H. pylori-infected non-Malay immigrants. The factors responsible for low H. pylori acquisition, transmission, and burden of H. pylori infection in Malays remain unclear and likely involves a combination of environmental, host (gene polymorphisms), and strain virulence factors. Based on evidence from this population, absence of H. pylori infection is more likely to be boon than a bane.
... [18][19][20][21][22][23][24][25][26][27][28][29][30] Obesity is a risk factor associated with GERD and other GI disorders. [31][32] Evaluation of age-associated UGIB may improve early diagnosis and further management. Serious UGIB commonly occurs during the 4th, 5th, and 6th decades of life, together with related sonographic images, whereas nonserious UGIB, with lower mortality and morbidity rates, occurs more frequently during the 2nd and 3rd decades of life. ...
Article
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In countries endemic for liver and GIT diseases, frequent emergency department (ED) patients contribute to a disproportionate number of visits consuming substantial amount of medical resources. One of the most frequent ED visits is patients who present with hypovolemic shock, abdominal pain, or confusion with or without signs of upper gastrointestinal bleeding (UGIB). The use of conventional two-dimensional ultrasound (2D-U/S) may provide immediate and useful information on the presence of esophageal varices, gastrointestinal tumors, and other GIT abnormalities. The current study investigated the feasibility of using (2D-U/S) to predict the source of UGIB in ED and to determine patients’ priority for UGE. Between February 2003 and March 2013, we retrospectively reviewed the profiles of 38,551 Egyptian patients, aged 2 to 75 years old, who presented with a history of GI/liver diseases and no alcohol consumption. We assessed the value of 2D-U/S technology in predicting the source of UGIB. Of 38,551 patients presenting to ED, 900 patients (2.3%), 534 male (59.3%) and 366 female (40.7%) developed UGIB. Analyzing results obtained from U/S examinations by data mining for emergent UGE were patients with liver cirrhosis (LC), splenomegaly, and ascites (42.6% incidence of UGIB), followed by LC and splenomegaly (14.6%), LC only (9.4%), and was only 0.5% who had no morbidity finding by 2D-U/S. Ultrasonographic instrumentation increases the feasibility of predictive emergency medicine. The area has recently not only gained a fresh impulse, but also a new set of complex problems that needs to be addressed in the emergency medicine setting according to each priority.
... The strengths of the present study include the population-based design with random selection of participants, the high participation rate, and the large sample size. Moreover, symptoms of GERD were measured with a well-validated questionnaire [21] , fulfilling the consensus criteria for GERD [1] . Furthermore, it was possible to adjust the results for several potential confounding factors. ...
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To clarify the association between physical activity and gastroesophageal reflux disease (GERD) in non-obese and obese people. A Swedish population-based cross-sectional survey was conducted. Participants aged 40-79 years were randomly selected from the Swedish Registry of the Total Population. Data on physical activity, GERD, body mass index (BMI) and the covariates age, gender, comorbidity, education, sleeping problems, and tobacco smoking were obtained using validated questionnaires. GERD was self-reported and defined as heartburn or regurgitation at least once weekly, and having at least moderate problems from such symptoms. Frequency of physical activity was categorized into three groups: (1) "high" (several times/week); (2) "intermediate" (approximately once weekly); and (3) "low" (1-3 times/mo or less). Analyses were stratified for participants with "normal weight" (BMI < 25 kg/m²), "overweight" (BMI 25 to ≤ 30 kg/m²) and "obese" (BMI > 30 kg/m²). Multivariate logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for potential confounding by covariates. Of 6969 eligible and randomly selected individuals, 4910 (70.5%) participated. High frequency of physical activity was reported by 2463 (50%) participants, GERD was identified in 472 (10%) participants, and obesity was found in 680 (14%). There were 226 (5%) individuals with missing information about BMI. Normal weight, overweight and obese participants were similar regarding distribution of gender and tobacco smoking status, while obese participants were on average slightly older, had fewer years of education, more comorbidity, slightly more sleeping problems, lower frequency of physical activity, and higher occurrence of GERD. Among the 2146 normal-weight participants, crude point estimates indicated a decreased risk of GERD among individuals with high frequency of physical activity (OR: 0.59, 95% CI: 0.39-0.89), compared to low frequency of physical activity. However, after adjustment for potential confounding factors, neither intermediate (OR: 1.30, 95% CI: 0.75-2.26) nor high (OR: 0.99, 95% CI: 0.62-1.60) frequency of physical activity was followed by decreased risk of GERD. Sleeping problems and high comorbidity were identified as potential confounders. Among the 1859 overweight participants, crude point estimates indicated no increased or decreased risk of GERD among individuals with intermediate or high frequency of physical activity, compared to low frequency. After adjustment for confounding, neither intermediate (OR: 0.75, 95% CI: 0.46-1.22) nor high frequency of physical activity were followed by increased or decreased risk of GERD compared to low frequency among nonobese participants. Sleeping problems and high comorbidity were identified as potential confounders for overweight participants. In obese individuals, crude ORs were similar to the adjusted ORs and no particular confounding factors were identified. Intermediate frequency of physical activity was associated with a decreased occurrence of GERD compared to low frequency of physical activity (adjusted OR: 0.41, 95% CI: 0.22-0.77). Intermediate frequency of physical activity might decrease the risk of GERD among obese individuals, while no influence of physical activity on GERD was found in non-obese people.
... High BMI is a major risk factor for EAC, with the risk directly increasing with increasing BMI. [4][5][6][7] Moreover, an Australian study found that the population attributable fraction for overweight/obese in EAC was as high as 31%. 8 In contrast, observational and cohort studies have shown that BMI is inversely associated with ESCC. ...
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Background: Studies based on Western populations have found that body mass index (BMI) is positively related to the risk of esophageal adenocarcinoma but inversely associated with esophageal squamous cell carcinoma (ESCC). Little reliable evidence exists of an association between BMI and ESCCin China, where ESCC incidence is high but BMI is low. Methods: We evaluated the BMI-ESCC association in a population-based prospective study of 29 446 Chinese aged 40-69 with 27 years of follow-up. China-specific BMI cut-offs (underweight < 18.5, healthy ≥ 18.5 to <24, overweight ≥ 24 to <28, and obese ≥ 28) and quartile categories were used to define BMI subgroups. Adjusted hazard ratios (HRs) and confidence intervals (CIs) for death from ESCC by BMI subgroups were calculated using Cox proportional hazards models. Results: During a median follow-up duration of 21.2 years (555 439 person-years), 2436 ESCC deaths were identified. BMI was protective for death from ESCC with an HR of 0.97 (95% CI 0.95-0.99) for each unit increase in BMI. Relative to healthy weight, HRs for BMI were 1.21 (95% CI 1.02-1.43) for the underweight group and 0.87 (95% CI 0.78-0.98) for the overweight. Categorical quartile analyses found people with BMIs in the Q3 and Q4 groups had 16% and 13% reductions in the risk of ESCC, respectively. Gender-specific analyses found that clear effects were evident in women only. Conclusions: Higher BMI was associated with a reduced risk of ESCC in aChinese population.
... In another study performed in the city of Olmsted (USA) where 90% of the population consisted of Caucasians, the prevalence of GERD was found to be 18.1% (21). According to the data from other Western countries, the prevalence rates vary between 8.5% and 18% (22)(23)(24)(25)(26). In the cumulative evaluation of Western data, the rate of prevalence was 16.1% for GERD, 23% for heartburn and 23% for regurgitation. ...
... [18][19][20][21][22][23][24][25][26][27][28][29][30] Obesity is a risk factor associated with GERD and other GI disorders. [31][32] Evaluation of age-associated UGIB may improve early diagnosis and further management. Serious UGIB commonly occurs during the 4th, 5th, and 6th decades of life, together with related sonographic images, whereas nonserious UGIB, with lower mortality and morbidity rates, occurs more frequently during the 2nd and 3rd decades of life. ...
Article
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The Value of U/S to Determine Priority for Upper Gastrointestinal Endoscopy in Emergency Room ( Observational Study )
... Esophageal adenocarcinoma can arise in patients with GERD and reflux esophagitis, as a result of glandular metaplasia of the normally squamous esophageal epithelium (Barrett's esophagus) [4]. Recently, worldwide, the morbidity and mortality from esophageal adenocarcinoma have been increasing [5,6]. ...
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Background The effects of Helicobacter pylori (H. pylori) infection on gastroesophageal reflux disease (GERD) remain unclear. The aim of this study was to compare the results of clinical esophageal function tests and the effect of H. pylori infection on GERD. Material/Methods A prospective clinical study included 124 patients diagnosed with GERD (four grades). H. pylori infection was determined by gastroscopy and a rapid urease test (RUT) to divide patients into an HP-positive and an HP-negative group. Esophageal function tests included high-resolution manometry (HRM), peristalsis break (PB), and 24-hour pH monitoring (composite pH DeMeester score). Different grades of GERD, with and without H. pylori infection, esophageal function test results were analyzed. Results The HP-positive group, compared with the HP-negative group with GERD, showed a significantly reduced median PB value (3.41±3.65 vs. 6.18±5.27), reduced PBs >5 cm per ten swallows (2.23±3.05 vs. 4.04±3.70) indicating that that H. pylori infection improved esophageal peristalsis. During 24-hour esophageal pH monitoring, the HP-positive group showed a significantly reduced percentage of time for esophageal pH <4.0, number of reflux events >5 min, and number of reflux episodes in 24 hours, compared with the HP-negative group. The DeMeester score was significantly increased in the HP-negative group, indicating a higher esophageal acid exposure (9.11±8.15 vs. 24.30±30.27). Conclusions H. pylori infection improved esophageal peristalsis, enhanced lower esophageal sphincter (LES) pressure, and reduced esophageal acid exposure, which might be protective factors for GERD.
... These risk factors include intake of fatty and non-vegetarian foods, carbonated drinks, coffee/tea, high level of urbanization, and presence of obesity. In fact, several studies did support the fact that variation in the frequency of GERD in Asian and Western countries might be related to the frequency of different risk factors in different population [30,5,8,18,23,38,43,54,58,59,62]. Risk factors for GERD reported in the studies from the Western countries included age (35-59 years), use of non-steroidal anti-inflammatory drugs (NSAIDs), lower income, socioeconomic status, urbanization, genetic factors, family history of GERD, obesity, and consumption of carbonated drinks. ...
Article
Background Indian population–based studies on the prevalence and risk factors for gastroesophageal reflux disease (GERD) are scanty, and a meta-analysis and a meta-regression of prevalence and risk factors based on the existing data have not yet been reported.MethodsA systematic review of all the available publications from India reporting data regarding prevalence and risk factors of GERD was performed. Heterogeneity was assessed using I2 statistics. The meta-analysis was undertaken to measure the average proportion reported in the existing studies, and meta-regression models were used to explore the risk factors for it.ResultsThe nine studies included 20,614 subjects; the prevalence of GERD ranged from 5% to 28.5%. The summary effect size (weighted average proportion) estimated by meta-analytic model was 0.1415 (95% confidence interval [CI] 0.099 to 0.197). The results for the test of heterogeneity that included tau2 (0.37, 95% CI 0.21 to 1.80), I2 (98.9%, 95% CI 98.01 to 99.77), and the Q-statistic (707.670; p < 0.0001) suggested high heterogeneity in the effect sizes. The pooled proportion of GERD (random-effects model) was 15.573 (95% CI 11.046 to 20.714). In the meta-regression model, sample size (p = 0.005) explained about 50% of the heterogeneity.Conclusion The pooled prevalence of GERD in the Indian population is 15.6 (95% CI 11.046 to 20.714). The risk factors were age, body mass index (BMI), non-vegetarian diet, tea/coffee intake, tobacco, and alcohol consumption. However, there was significant heterogeneity in the studies.
... Gastroesophageal reflux disease (GERD) has increased in Europe and the United States over the past decades [1][2][3]. GERD symptoms are among the most common gastrointestinal symptoms in those regions [4], with prevalence rates of 10-25% reported from population-based studies [2,[5][6][7][8]. Several population-based studies from Iran, in West Asia, have reported prevalence rates similar to those in Western countries [9][10][11]. ...
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Gastroesophageal reflux disease (GERD) is a common cause of discomfort and morbidity worldwide. However, information on determinants of GERD from large-scale studies in low- to medium-income countries is limited. We investigated the factors associated with different measures of GERD symptoms, including frequency, patient-perceived severity, and onset time. We performed a cross-sectional analysis of the baseline data from a population-based cohort study of ∼50,000 individuals in in Golestan Province, Iran. GERD symptoms in this study included regurgitation and/or heartburn. Approximately 20% of participants reported at least weekly symptoms. Daily symptoms were less commonly reported by men, those of Turkmen ethnicity, and nass chewers. On the other hand, age, body mass index, alcohol drinking, cigarette smoking, opium use, lower socioeconomic status, and lower physical activity were associated with daily symptoms. Most of these factors showed similar associations with severe symptoms. Women with higher BMI and waist to hip ratio were more likely to report frequent and severe GERD symptoms. Hookah smoking (OR 1.34, 95% CI 1.02-1.75) and opium use (OR 1.70, 95% CI 1.55-1.87) were associated with severe symptoms, whereas nass chewing had an inverse association (OR 0.87, 95% CI 0.76-0.99). After exclusion of cigarette smokers, hookah smoking was still positively associated and nass chewing was inversely associated with GERD symptoms (all frequencies combined). GERD is common in this population. The associations of hookah and opium use and inverse association of nass use with GERD symptoms are reported for the first time. Further studies are required to investigate the nature of these associations. Other determinants of GERD were mostly comparable to those reported elsewhere.
Article
Background: Gastro-oesophageal reflux disease (GORD) is assessed by two reflux symptom items in the oesophageal-specific module (QLQ-OES18) of the health-related quality of life (HRQL) questionnaire developed by EORTC. This study validated such assessment of GORD. Methods: This validation study included a random sample of the Swedish population, aged 40-79years, who completed the QLQ-OES18 ('test questionnaire') and a more comprehensive reflux questionnaire ('standard questionnaire') in 2008. In the 'test questionnaire', GORD was defined using two cut-offs for reflux symptoms experienced during the last week. 'Definition 1' represented responses 'quite a bit' or more reflux symptoms and 'definition 2' represented 'a little' or more reflux symptoms. The 'standard questionnaire' assessed GORD during the last 3months. Results: Among 6969 invited individuals, 4910 (70.5%) responded to both questionnaires. There were generally good correlations between the responses to the individual reflux items in the comparison questionnaires. Compared to the 'standard questionnaire', 'definition 1' of GORD in the 'test questionnaire' showed high positive predictive value (0.81), high negative predictive value (0.93) and high specificity (0.99), but low sensitivity (0.32); while 'definition 2' of GORD rendered low positive predictive value (0.39), high negative predictive value (0.98), moderate specificity (0.85) and moderate sensitivity (0.83). Conclusions: The assessment of GORD in the QLQ-OES18 questionnaire would benefit from adding items and assessing a longer period of history of reflux symptoms and its treatment. As it stands, the choice of cut-off for the response alternatives strongly influences the specificity and sensitivity of the GORD assessment.
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Background: Barrett's esophagus(BE) is a premalignant condition associated with chronic gastro-esophageal reflux disease (GERD). As only a small proportion of BE progresses to malignancy, it is important to study BE prevalence to prevent adenocarcinoma. Materials and methods: Between January 2007 and December 2010, all consecutive individuals who underwent routine upper endoscopy were prospectively recruited. Patients referred for GERD were excluded from the study. Clinical and endoscopic data were collected. Results: A total of 1,990 patients (mean age 47.48±13.4 years; 52.8% males) were included. Of them, 496 (24.9%) reported GERD. Erosive esophagitis (EE) was found in 221 participants (11.1%, 193 patients with LA grade A and 28 patients with LA grade B). Overall 31 of 1494 participants not reporting reflux symptoms (2.07%) suffered from silent GERD. BE was diagnosed in 75 participants (3.77%), four (5.3%) with long-segment BE and 71 (94.7%) with short-segment BE. Low-grade dysplasia was noticed in 1 patient with long-segment BE. Hiatal hernia (HH) was found in 196 patients (9.8%), and mean HH length was 3.22 ± 0.2 cm. BE was correlated to EE, GERD and the presence of HH (p= 0.0167, <0.001 and 0.017, respectively) whereas it was not associated with age, alcohol consumption and smoking (p= 0.057, 0.099 and 0.06, respectively). BE was not correlated with Helicobacter pylori infection (p=0.542). Conclusion: The prevalence of BE was 3.77% in a Greek population undergoing upper endoscopy not referred for GERD. Long-segment BE was very uncommon (0.2%) whereas 2.07% of patients not reporting symptoms suffered from silent GERD.
Article
Barrett's esophagus (BO) is a precursor of esophageal adenocarcinoma (OAC), a cancer with a poor prognosis and an increasing incidence. Hence there is an interest in mapping causal factors underlying BO and finding strategies to reduce the risk of dysplasia progression in patients with BO. Here we review current knowledge on established as well as less risk factors for the development of BO. Additionally, we summarize today's status on the use of chemoprevention aiming to reduce the risk of cancer progression in BO patients. We searched Medline and the Cochrane Library using the MeSH terms "Barrett's esophagus" and "Barrett esophagus," both alone and combined with the terms "risk factor," "aetiology," "diet," or "prevention." Focus was on original contributions, systematic reviews, and meta-analyses. Established risk factors for the development of BO include gastro-esophageal reflux, obesity, male gender, Caucasian ethnicity, and increasing age. Smoking might increase the risk of BO, while aspirin/NSAIDs, Helicobacter pylori infection, and specific "healthy" dietary factors may lower the risk. The potential value of using chemoprevention with proton pump inhibitors, aspirin/NSAIDs, or statins is still uncertain. There is today a substantial knowledge of risk factors of BO. Certain diet may be protective of BO, albeit yet to be proven. The efficiency of chemoprevention in BO is currently addressed further in randomized clinical trials.
Article
Columnar lined esophagus (CLE) is a marker for gastroesophageal reflux and associates with an increased cancer risk among those with Barrett's esophagus. Recent studies fostered the development of integrated CLE concepts. Using PubMed, we conducted a review of studies on novel histopathological concepts of nondysplastic CLE. Two histopathological concepts-the squamo-oxyntic gap (SOG) and the dilated distal esophagus (DDE), currently model our novel understanding of CLE. As a consequence of reflux, SOG interposes between the squamous lined esophagus and the oxyntic mucosa of the proximal stomach. Thus the SOG describes the histopathology of CLE within the tubular esophagus and the DDE, which is known to develop at the cost of a shortened lower esophageal sphincter and foster increased acid gastric reflux. Histopathological studies of the lower end of the esophagus indicate, that the DDE is reflux damaged, dilated, gastric type folds forming esophagus and cannot be differentiated from proximal stomach by endoscopy. While the endoscopically visible squamocolumnar junction (SCJ) defines the proximal limit of the SOG, the assessment of the distal limit requires the histopathology of measured multilevel biopsies. Within the SOG, CLE types distribute along a distinct zonation with intestinal metaplasia (IM; Barrett's esophagus) and/or cardiac mucosa (CM) at the SCJ and oxyntocardiac mucosa (OCM) within the distal portion of the SOG. The zonation follows the pH-gradient across the distal esophagus. Diagnosis of SOG and DDE includes endoscopy, histopathology of measured multi-level biopsies from the distal esophagus, function, and radiologic tests. CM and OCM do not require treatment and are surveilled in 5 year intervals, unless they associate with life quality impairing symptoms, which demand medical or surgical therapy. In the presence of an increased cancer risk profile, it is justified to consider radiofrequency ablation (RFA) of IM within clinical studies in order to prevent the progression to dysplasia and cancer. Dysplasia justifies RFA ± endoscopic resection. SOG and DDE represent novel concepts fusing the morphological and functional aspects of CLE. Future studies should examine the impact of SOG and DDE for monitoring and management of gastroesophageal reflux disease (GERD).
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Gastroesophageal reflux (GER) affects ∼10-20% of American adults. Although symptoms are equally common in men and women, we hypothesized that sex influences diagnostic and therapeutic approaches in patients with GER. PubMed database between 1997 and October 2011 was searched for English language studies describing symptoms, consultative visits, endoscopic findings, use and results of ambulatory pH study, and surgical therapy for GER. Using data from Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, we determined the sex distribution for admissions and reflux surgery between 1997 and 2008. Studies on symptoms or consultative visits did not show sex-specific differences. Even though women are less likely to have esophagitis or Barrett's esophagus, endoscopic studies enrolled as many women as men, and women were more likely to undergo ambulatory pH studies with a female predominance in studies from the US. Surgical GER treatment is more commonly performed in men. However, studies from the US showed an equal sex distribution, with Nationwide Inpatient Sample data demonstrating an increase in women who accounted for 63% of the annual fundoplications in 2008. Despite less common or severe mucosal disease, women are more likely to undergo invasive diagnostic testing. In the US, women are also more likely to undergo antireflux surgery. These results suggest that healthcare-seeking behavior and socioeconomic factors rather than the biology of disease influence the clinical approaches to reflux disease.
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The purpose of this study was to determine the levels of overweight/obesity among middle school students in a school district in southeast Texas by comparing the current statistics (school year 2011–2012) with those in the previous year (2010–2011). Using FITNESSGRAM, teachers reported archival body mass index (BMI) data of middle school students (N = 1991; 51.88% boys and 48.12% girls) reported between 2011 and 2012 which were examined with cross-sectional analysis by grade, age, and gender and then compared to the previous year's data (2010–2011; N = 2908; 52.5% boys and 47.5% girls) to determine the trend of obesity levels among students in the district. The students' BMI was percentile ranked using Centers for Disease Control and Prevention's >85th percentile rating as an index for overweight or BMI above the 95th percentile as an index of access fat, an indication of obesity. Results indicate a slight increase in overweight and obesity levels from the previous year, especially among female students aged 12–13 years (m = 21.74, SD = 1.017 vs. m = 24.56, SD = 1.129). Based on these findings, the prevalence of obese children in the district (2011–2012) was 16.26% compared to the previous year (2010–2011) of 14.63%. The results demonstrate the prevalence of overweight and obesity and indicate an increasing trend for this age group. Physical educators should incorporate activities to motivate children of this age group and encourage them to become more physically active and reverse this current trend.
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United European Gastroenterology (UEG) which represents gastroenterology and hepatology and its sub-disciplines across Europe relies on accurate and up to date information on the burden of gastrointestinal diseases in Europe, the availability and quality of diagnostic and therapeutic services and the economic impact of these diseases across the member countries of the European Union to inform its strategy in advising relevant agencies on future clinical services and research priorities. Determining the trajectory of the morbidity and mortality of digestive diseases is vital in planning health services for the future and in making the case for investment in research where there are clear gaps in knowledge. In addition there are marked economic differences across the member nations in Europe and this is reflected in the funding available to support health services, making it highly likely that there are important disparities in the accessibility to high-quality healthcare. In September 2012 the UEG Council accepted a proposal from the UEG Future Trends Committee to commission a detailed survey of digestive health across Europe. The Future Trends Committee developed an outline framework for the study, following which there was an open, competitive process across Europe to identify a competent research group to undertake the project. The contract was awarded to an experienced group within the College of Medicine, Swansea University, United Kingdom, and the project was formally initiated in April 2013. The research group at Swansea has worked closely with the Committee, including an interim update meeting with the Committee in October 2013. The Committee also had the opportunity to make specific comments on a draft final report submitted in May 2014; a final report, Survey of Digestive Health Across Europe was received in August 2014. The final report is organised into two parts: Part 1, The burden of gastrointestinal diseases and the organisation and delivery of gastroenterology services across Europe and Part 2, The economic impact and burden of digestive disorders. We present here the executive summaries of the two parts of the survey, but the full report can be found on the UEG journal website. It is anticipated that several shorter publications will follow, focusing on some specific topics of particular importance and interest. Michael Farthing President United European Gastroenterology
Article
Objective: To update the findings of the 2005 systematic review of population-based studies assessing the epidemiology of gastro-oesophageal reflux disease (GERD). Design: PubMed and Embase were screened for new references using the original search strings. Studies were required to be population-based, to include ≥ 200 individuals, to have response rates ≥ 50% and recall periods <12 months. GERD was defined as heartburn and/or regurgitation on at least 1 day a week, or according to the Montreal definition, or diagnosed by a clinician. Temporal and geographic trends in disease prevalence were examined using a Poisson regression model. Results: 16 studies of GERD epidemiology published since the original review were found to be suitable for inclusion (15 reporting prevalence and one reporting incidence), and were added to the 13 prevalence and two incidence studies found previously. The range of GERD prevalence estimates was 18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. Incidence per 1000 person-years was approximately 5 in the overall UK and US populations, and 0.84 in paediatric patients aged 1-17 years in the UK. Evidence suggests an increase in GERD prevalence since 1995 (p<0.0001), particularly in North America and East Asia. Conclusions: GERD is prevalent worldwide, and disease burden may be increasing. Prevalence estimates show considerable geographic variation, but only East Asia shows estimates consistently lower than 10%.
Article
High serum leptin levels characterize obesity, an established risk factor for many cancers. There is compelling and growing peer-reviewed scientific evidence that leptin plays a direct role in the development and progression of specific cancers. This chapter discusses some of this evidence. The mediating molecular mechanisms are often complex and in specific cases involve dysregulation of the cell cycle. Our current understanding of the role of leptin in carcinogenesis has already revealed aspects for potential clinical applications.
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Gastroesophageal reflux disease (GERD) and its many manifestations are common in North America and Europe. Although less common in Asia, Middle East, Caribbean, and African countries, its prevalence is increasing in these regions as well. Although the incidence of new cases is relatively low, the disease persists over long periods of time, thereby leading to an overall high prevalence. Risk factors include age, gender, ethnicity, obesity, physiologic/anatomic conditions, and lifestyle. GERD is an economic burden to patients, healthcare systems, employers, and society. Barrett’s esophagus is one of the more serious consequences of GERD. Its primary importance is as a risk factor for esophageal adenocarcinoma. Although prevalence and incidence of Barretts is difficult to determine, it is probably more common than initially believed. Risk factors are similar to GERD, although diet may play an additional role.
Article
OBJECTIVE: Investigate the expression of EGFR, ODC, CDH mRNA in the progress of reflux esophagitis. METHODS: Thirty-four SD rats were divided into two groups randomly. Model group were treated as esophagoduodenostomy(n=28), Control group were normal control(n=6). The lesions of esophageal mucosa were observed in the 5th, 17th, 28th and 40th week in model group and 40th week in control group respectively. Evaluated the change of EGFR, ODC and CDH mRNA by RT-PCR in the progress of reflux esophagitis. RESULTS: The expression of EGFR mRNA were increased gradually from normal to RE, BE and EAC, and had significant difference between each other(P<0.05). The expression of ODC mRNA were increased gradually from normal to RE, BE and EAC, the expression of ODC mRNA were higher in BE and EAC than that in normal and RE(P<0.05), and there was significant difference between BE and EAC(P<0.05). CDH mRNA were decreased gradually in the development of RE, the expression of CDH mRNA were lower in BE and EAC than that in normal and RE(P<0.05), and there was no significant difference between BE and EAC(P>0.05). CONCLUSIONS: In the progress of RE, EGFR mRNA, ODC mRNA increased gradually, CHD mRNA decreased gradually. This suggests that enhanced expression of EGFR mRNA, ODC mRNA and decreased expression of CHD mRNA may occur early during Barrett's-associated neoplastic transformation.
Chapter
Gastroesophageal reflux disease (GERD) is a common condition seen worldwide. The prevalence in North America and Europe ranges from 8.8% to 30% and is lower in Asia, ranging anywhere from 3.5% to 8.5%. GERD also can cause esophageal strictures and Barrett esophagus, and has a significant impact on patients' quality of life. Additionally, GERD results in millions of office visits, missed days of work, and lost productivity. In this chapter we explore the epidemiology of GERD along with the full scope of the problem, including the effect it has on patients' quality of life and economic burden.
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The increasing incidence of obesity and its co-morbid conditions poses a great challenge to global health. In addition to cardiovascular disease and diabetes, epidemiological data demonstrate a link between obesity and multiple types of cancer. The molecular mechanisms underlying how obesity causes an increased risk of cancer are poorly understood. Obesity disrupts the dynamic role of the adipocyte in energy homeostasis, resulting in inflammation and alteration of adipokine (for example, leptin and adiponectin) signalling. Additionally, obesity causes secondary changes that are related to insulin signalling and lipid deregulation that may also foster cancer development. Understanding these molecular links may provide an avenue for preventive and therapeutic strategies to reduce cancer risk and mortality in an increasingly obese population.
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Incidence rates have risen rapidly for esophageal adenocarcinoma and moderately for gastric cardia adenocarcinoma, while rates have remained stable for esophageal squamous cell carcinoma and have declined steadily for noncardia gastric adenocarcinoma. We examined anthropometric risk factors in a population-based case-control study of esophageal and gastric cancers in Connecticut, New Jersey, and western Washington. Healthy control subjects (n = 695) and case patients with esophageal squamous cell carcinoma or noncardia gastric adenocarcinoma (n = 589) were frequency-matched to case patients with adenocarcinomas of esophagus or gastric cardia (n = 554) by 5-year age groups, sex, and race (New Jersey only). Classification of cases by tumor site of origin and histology was determined by review of pathology materials and hospital records. Data were collected using in-person structured interviews. Associations with obesity, measured by body mass index (BMI), were estimated by odds ratios (ORs). All ORs were adjusted for geographic location, age, sex, race, cigarette smoking, and proxy response status. The ORs for esophageal adenocarcinoma rose with increasing adult BMI. The magnitude of association with BMI was greater among the younger age groups and among nonsmokers. The ORs for gastric cardia adenocarcinoma rose moderately with increasing BMI. Adult BMI was not associated with risk of esophageal squamous cell carcinoma or noncardia gastric adenocarcinoma. Increasing prevalence of obesity in the United States population may have contributed to the upward trends in esophageal and gastric cardia adenocarcinomas.
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Incidence rates for adenocarcinomas of the esophagus and gastric cardia have risen steeply over the last few decades. To determine risk factors for these tumors, we conducted a multicenter, population-based, case-control study. The study included 554 subjects newly diagnosed with esophageal or gastric cardia adenocarcinomas, 589 subjects newly diagnosed with esophageal squamous cell carcinoma or other gastric adenocarcinomas, and 695 control subjects. Estimates of risk (odds ratios [ORs] and corresponding 95% confidence intervals [CIs]) were calculated for the four tumor types separately and for esophageal and gastric cardia adenocarcinomas combined. Risk of esophageal and gastric cardia adenocarcinomas combined was increased among current cigarette smokers (OR = 2.4; 95% = 1.7-3.4), with little reduction observed until 30 years after smoking cessation; this risk rose with increasing intensity and duration of smoking. Risk of these tumors was not related to beer (OR = 0.8; 95% CI = 0.6-1.1) or liquor (OR = 1.1; 95% CI = 0.8-1.4) consumption, but it was reduced for drinking wine (OR = 0.6; 95% CI = 0.5-0.8). Similar ORs were obtained for the development of noncardia gastric adenocarcinomas in relation to tobacco and alcohol use, but higher ORs were obtained for the development of esophageal squamous cell carcinomas. For all four tumor types, risks were higher among those with low income or education. Smoking is a major risk factor for esophageal and gastric cardia adenocarcinomas, accounting for approximately 40% of cases. Because of the long lag time before risk of these tumors is reduced among ex-smokers, smoking may affect early stage carcinogenesis. The increase in smoking prevalence during the first two thirds of this century may be reflected in the rising incidence of these tumors in the past few decades among older individuals. The recent decrease in smoking may not yet have had an impact.
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The causes of adenocarcinomas of the esophagus and gastric cardia are poorly understood. We conducted an epidemiologic investigation of the possible association between gastroesophageal reflux and these tumors. We performed a nationwide, population-based, case-control study in Sweden. Case ascertainment was rapid, and all cases were classified uniformly. Information on the subjects' history of gastroesophageal reflux was collected in personal interviews. The odds ratios were calculated by logistic regression, with multivariate adjustment for potentially confounding variables. Of the patients interviewed, the 189 with esophageal adenocarcinoma and the 262 with adenocarcinoma of the cardia constituted 85 percent of the 529 patients in Sweden who were eligible for the study during the period from 1995 through 1997. For comparison, we interviewed 820 control subjects from the general population and 167 patients with esophageal squamous-cell carcinoma. Among persons with recurrent symptoms of reflux, as compared with persons without such symptoms, the odds ratios were 7.7 (95 percent confidence interval, 5.3 to 11.4) for esophageal adenocarcinoma and 2.0 (95 percent confidence interval, 1.4 to 2.9) for adenocarcinoma of the cardia. The more frequent, more severe, and longer-lasting the symptoms of reflux, the greater the risk. Among persons with long-standing and severe symptoms of reflux, the odds ratios were 43.5 (95 percent confidence interval, 18.3 to 103.5) for esophageal adenocarcinoma and 4.4 (95 percent confidence interval, 1.7 to 11.0) for adenocarcinoma of the cardia. The risk of esophageal squamous-cell carcinoma was not associated with reflux (odds ratio, 1.1; 95 percent confidence interval, 0.7 to 1.9). There is a strong and probably causal relation between gastroesophageal reflux and esophageal adenocarcinoma. The relation between reflux and adenocarcinoma of the gastric cardia is relatively weak.
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Objective To update the findings of the 2005 systematic review of population-based studies assessing the epidemiology of gastro-oesophageal reflux disease (GERD). Design PubMed and Embase were screened for new references using the original search strings. Studies were required to be population-based, to include ≥200 individuals, to have response rates ≥50% and recall periods <12 months. GERD was defined as heartburn and/or regurgitation on at least 1 day a week, or according to the Montreal definition, or diagnosed by a clinician. Temporal and geographic trends in disease prevalence were examined using a Poisson regression model. Results 16 studies of GERD epidemiology published since the original review were found to be suitable for inclusion (15 reporting prevalence and one reporting incidence), and were added to the 13 prevalence and two incidence studies found previously. The range of GERD prevalence estimates was 18.1%–27.8% in North America, 8.8%–25.9% in Europe, 2.5%–7.8% in East Asia, 8.7%–33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. Incidence per 1000 person-years was approximately 5 in the overall UK and US populations, and 0.84 in paediatric patients aged 1–17 years in the UK. Evidence suggests an increase in GERD prevalence since 1995 (p<0.0001), particularly in North America and East Asia. Conclusions GERD is prevalent worldwide, and disease burden may be increasing. Prevalence estimates show considerable geographic variation, but only East Asia shows estimates consistently lower than 10%.
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To measure the relative risks of adenocarcinomas of the oesophagus and gastro-oesophageal junction associated with measures of obesity, and their interactions with age, sex, gastro-oesophageal reflux symptoms and smoking. Population-based case-control study in Australia. Patients with adenocarcinomas of the oesophagus (n = 367) or gastro-oesophageal junction (n = 426) were compared with control participants (n = 1580) sampled from a population register. Relative risk of adenocarcinoma of the oesophagus or gastro-oesophageal junction. Risks of oesophageal adenocarcinoma increased monotonically with body mass index (BMI) (p(trend) <0.001). Highest risks were seen for BMI >or=40 kg/m2 (odds ratio (OR) = 6.1, 95% CI 2.7 to 13.6) compared with "healthy" BMI (18.5-24.9 kg/m2). Adjustment for gastro-oesophageal reflux and other factors modestly attenuated risks. Risks associated with obesity were substantially higher among men (OR = 2.6, 95% CI 1.8 to 3.9) than women (OR = 1.4, 95% CI 0.5 to 3.5), and among those aged <50 years (OR = 7.5, 95% CI 1.7 to 33.0) than those aged >or=50 years (OR = 2.2, 95% CI 1.5 to 3.1). Obese people with frequent symptoms of gastro-oesophageal reflux had significantly higher risks (OR = 16.5, 95% CI 8.9 to 30.6) than people with obesity but no reflux (OR = 2.2, 95% CI 1.1 to 4.3) or reflux but no obesity (OR = 5.6, 95% 2.8 to 11.3), consistent with a synergistic interaction between these factors. Similar associations, but of smaller magnitude, were seen for gastro-oesophageal junction adenocarcinomas. Obesity increases the risk of oesophageal adenocarcinoma independently of other factors, particularly among men. From a clinical perspective, these data suggest that patients with obesity and frequent symptoms of gastro-oesophageal reflux are at especially increased risk of adenocarcinoma.
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Most trials of non-ulcer dyspepsia (NUD) and Helicobacter pylori associated gastritis (HPAG) have not used validated methods of measuring symptoms. Three attributes are necessary for use of symptom severity scoring systems as outcome measures in clinical trials: reproducibility, responsiveness to change and validity compared to corroborating measures. The objective of this study was to establish that selected gastrointestinal symptoms recorded as a series of 5-point Likert Scales meet the 3 criteria for use as outcome measures in clinical trials. Patients with NUD (Helicobacter pylori-negative) and HPAG were studied. A preliminary assessment of 24 patients was used to select the 8 most frequently occurring and most severe symptoms. These symptoms were then scored in a further 55 patients to assess their utility as outcome measures. Observations were made at 3 time points, enrollment (T1), after 1 week with no intervention (T2) and after 4 weeks of therapy for either disease (T3). The study took place in a university hospital outpatient gastroenterology service. Symptom scores were reproducible before treatment (symptom scores at T1 and T2 were correlated), responsive (symptom scores changed after treatment between T2 and T3) and valid (symptom score changes corresponded to changes in general health status). Scoring of gastrointestinal symptom severity using 5-point Likert Scales satisfies the 3 criteria for use as outcome measures in clinical trials of NUD and HPAG.
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To develop and validate a postal health status questionnaire which will identify people with dyspepsia in the general population. Validation against telephone interview and post re-post determination of reliability. A general practice population in the north of England. A random sample of adults aged 20-69 years inclusive chosen from the general population. Validity has been checked against telephone interview. A kappa statistic has been calculated for each question and clinical category. Compared with interview the questionnaire is a valid, comprehensive and easily understood record of symptomatology. The kappa statistics (mean value 0.92) indicate a very reliable questionnaire. The questionnaire accurately and reliably identifies people with dyspeptic symptoms.
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The rapidly rising incidence of esophageal adenocarcinomas in the United States and western Europe remains unexplained. Most persons who develop the disease have had long-standing gastroesophageal reflux symptoms with concomitant Barrett's metaplasia. They are, therefore, potentially identifiable for endoscopic screening and cancer surveillance, which should facilitate the early detection of these tumors. We undertook these analyses to determine the extent to which the opportunity for early diagnosis and treatment of esophageal adenocarcinomas has been realized in the US. Specifically, using data from the Surveillance, Epidemiology, and End Results (SEER) program of the US National Cancer Institute, we examined changes in stage of disease at diagnosis and in survival between 1973 and 1991 and investigated patient characteristics as predictors of survival. Improvements in stage at diagnosis and in survival between 1973 and 1991 were minor and clinically insignificant; overall five-year survival never exceeded 10 percent. Stage of disease at diagnosis was the strongest determinant of subsequent survival; five-year survival with patients with in situ tumors was 68.2 percent. This survival advantage persisted up to 15 years after diagnosis and was independent of other prognostic factors. We conclude that the opportunity for reduction in esophageal cancer mortality has been largely unrealized in the US. In light of the increasing incidence of esophageal adenocarcinoma, efforts should be devoted to identifying those at highest risk of developing Barrett's metaplasia and subsequent adenocarcinoma, and to developing cost-effective primary prevention and cancer surveillance methods targetting them.
Article
Although dietary exposures in the distant past are considered important in the etiology of several diseases, few studies have addressed methodological aspects of long-term (> or = 20 yrs) recall. We evaluated the reliability of retrospective self-reports about diet 20 years before the interview and consistency (between siblings) of self-reports about diet during adolescence in a population-based case-control study of stomach cancer in Sweden. Short-term reliability (a questionnaire self-administered 9-12 mos after the personal interview) of reports on diet 20 years ago by 374 control subjects showed mean correlation coefficients for 42 foods/beverages of 0.41 (Pearson) and 0.46 (Spearman) and a mean weighted kappa statistic of 0.42; for 15 nutrients/food constituents the corresponding mean values were 0.46, 0.47, and 0.42, respectively. Consistency of independent reports by siblings about their own diet during adolescence studied in 201 control-sibling pairs was modest. The mean Pearson correlation coefficient for 33 foods/beverages was 0.29, and the mean weighted kappa statistic was 0.30; at the nutrient level the means were 0.26 and 0.24, respectively. A comparison of intersibling differences between controls and stomach cancer cases revealed correlations of a similar magnitude (mean Pearson correlation for 33 foods = 0.29 for control-sibling and 0.27 for case-sibling pairs), thus contradicting differential recall. Our results imply that although reliability of self-reports about the diet in the distant past is generally lower than for the actual diet, we can use these measurements when remote time periods are of special interest in etiological epidemiologic studies.
Article
Seidell JC. Obesity: a growing problem. Acta Pædiatr 1999; Suppl 428: 46–50. Stockholm. ISSN 0803–5326 Obesity, defined as a body mass index (BMI) of 30 kg/m2 or more, is common in many parts of the world, especially in the established market economies, the former socialist economies of Europe, Latin America, the Caribbean and the Middle Eastern Crescent. As many as 250 million people worldwide may be obese (7% of the adult population) and two to three times as many may be considered overweight. The prevalence of obesity seems to be increasing in most parts of the world, even where it used to be rare. Increased fatness, measured by a high BMI, a large waist circumference or a high waist/hip circumference ratio, is associated with many chronic diseases as well as with poor physical functioning. Assessments of the prevalence of obesity, and trends in this prevalence over time, are more difficult in children than adults, due to the lack of international criteria for classifying individuals as overweight or obese. The World Health Organization has now recommended the use of BMI-for-age percentiles, but the reference curves are still under development. France, The Netherlands, the UK and the USA are among the countries that have reported recent increases in the prevalence of obesity in children and adolescents. Although there are no accurate estimates of the components of energy balance and their changes over time, the available evidence suggests that the trends in obesity rates are related more to a reduction in energy expenditure than to an increase in caloric intake. Prevention of obesity through the promotion of a healthy lifestyle is among the important challenges for the new millennium, and should start in childhood, □Adolescents, children, epidemiology, obesity, overweight
Article
The incidence of esophageal and gastric cardia adenocarcinoma is, for unknown reasons, increasing dramatically. A weak and inconsistent association between body mass index (BMI) and adenocarcinoma of the esophagus and gastric cardia has been reported. To reexamine the association between BMI and development of adenocarcinoma of the esophagus and gastric cardia. Nationwide, population-based case-control study. Sweden, 1995 through 1997. Patients younger than 80 years of age who had recently received a diagnosis were eligible. Comprehensive organization ensured rapid case ascertainment. Controls were randomly selected from the continuously updated population register. Interviews were conducted with 189 patients with adenocarcinoma of the esophagus and 262 patients with adenocarcinoma of the gastric cardia; for comparison, 167 patients with incident esophageal squamous-cell carcinoma and 820 controls were also interviewed. Odds ratios were determined from BMI and cancer case-control status. Odds ratios estimated the relative risk for the two adenocarcinomas studied and were calculated by multivariate logistic regression with adjustment for potential confounding factors. A strong dose-dependent relation existed between BMI and esophageal adenocarcinoma. The adjusted odds ratio was 7.6 (95% CI, 3.8 to 15.2) among persons in the highest BMI quartile compared with persons in the lowest. Obese persons (persons with a BMI > 30 kg/m2) had an odds ratio of 16.2 (CI, 6.3 to 41.4) compared with the leanest persons (persons with a BMI < 22 kg/m2). The odds ratio for patients with cardia adenocarcinoma was 2.3 (CI, 1.5 to 3.6) in those in the highest BMI quartile compared with those in the lowest BMI quartile and 4.3 (CI, 2.1 to 8.7) among obese persons. Esophageal squamous-cell carcinoma was not associated with BMI. The association between BMI and esophageal adenocarcinoma is strong and is not explained by bias or confounding. The carcinogenic mechanism, however, remains to be clarified. The increasing prevalence of obesity in western countries could be important in understanding the increasing occurrence of this tumor.
Article
While tobacco and alcohol are established risk factors for oesophageal squamous-cell carcinoma, their roles in the aetiology of the increasingly common oesophageal adenocarcinoma remains uncertain. We tested the association between tobacco, snuff and alcohol use and the risk of oesophageal and cardia cancer in a nationwide, population-based case-control study in Sweden. Face-to-face interviews were conducted with 618 (81% of all eligible) patients (189 oesophageal adenocarcinoma, 262 cardia adenocarcinoma and 167 oesophageal squamous-cell carcinoma) and 820 control subjects. Odds ratios (OR) were calculated by logistic regression with multivariate adjustments for potential confounding. The risk of oesophageal adenocarcinoma was not associated with snuff or alcohol use, and the association with smoking was weak or absent. Gastric cardia adenocarcinoma was dose-dependently associated with smoking (OR=4.2, 95% CI=2.5-7.0 among heavy smokers compared with never-smokers), but not with alcohol or snuff use. Oesophageal squamous-cell carcinoma was strongly associated with tobacco, moderately with alcohol, but not with snuff use; combined use of tobacco and alcohol entailed a strongly increased risk (OR=23.1, 95% CI=9.6-56.0 among heavy users compared with never-users). We conclude that tobacco smoking, a strong risk factor for oesophageal squamous-cell carcinoma and cardia adenocarcinoma, does not play an important role in the aetiology of oesophageal adenocarcinoma. None of the studied exposures can explain the increasing incidence of oesophageal adenocarcinoma.
Article
Patients consulting with gastro-oesophageal reflux symptoms (GORS) may differ from nonconsulters. To describe these differences in a UK population. A postal questionnaire was sent to 4432 adults. Definitions used were GORS (either heartburn or acid regurgitation on more than six occasions during the previous year), dyspepsia (upper abdominal pain or discomfort on more than six occasions during the previous year) and irritable bowel syndrome (abdominal pain with three or more Manning criteria). Socio-economic status was identified by the Standard Occupational Classification. With a 71.7% response, GORS were reported by 28.7% of the sample, it was unaffected by gender and age but was more common among the socially disadvantaged (P < 0. 005). Less than 25% of GORS patients consulted during the previous year. Increasing age (chi2 for trend; P < 0.001) and coexisting upper abdominal symptoms (chi2 P < 0.001) positively influenced consultation behaviour, but it was unaffected by socio-economic status, gender, or the coexistence of irritable bowel syndrome. Dyspepsia and nausea independently predicted consultation. GORS are especially common among the deprived. Socio-economic variables do not affect consultation behaviour, but the patient's age and the burden (number and type) of associated symptoms do.
Article
The Bristol Helicobacter Project is an ongoing, pragmatic, double-blind placebo-controlled trial of the effect of Helicobacter pylori eradication on symptoms of dyspepsia, health utilization and costs, and quality of life in the adult population. Commencing in 1996, 27,536 individuals ages 20-59 years who were registered with seven primary care centers in Bristol and the surrounding areas in southwest England were invited to undergo a 13C urea breath test. There was no selection on the basis of symptoms and 23.5% had dyspepsia on entry to the study. A total of 10,537 people were tested (38.3% of those invited), 1636 tested positive (15.5% of those tested), and 1558 (95.2% of those who tested positive) were randomized to H. pylori eradication therapy or placebo. The rate of participation in the screening phase increased with age (odds ratio [OR]: 1.42 per decade, 95% CI: 1.31 to 1.54) and female gender (OR: 1.35, 95% CI: 1.27 to 1.43) but decreased with lower socioeconomic status (OR: 0.70, 95% CI: 0.56 to 0.86 comparing lowest with highest category). H. pylori prevalence increased with age (OR: 1.69 per decade, 95% CI: 1.51 to 1.89) and lower socioeconomic status (OR: 1.33, 95% CI: 1.05 to 1.69) but was lower in women (OR: 0.87, 95% CI: 0.76 to 1.00). Population-based trials of H. pylori eradication are feasible but necessitate screening large numbers of people to identify those who are infected and who may benefit from eradication. In the Bristol Helicobacter Project the rate of participation varied inversely with both social deprivation and the prevalence of the infection.
Article
Our study provides an update of the incidence of oesophageal cancer in the West Midland region of England and Wales from 1992-96. A total of 2,671 cases of oesophageal cancer were identified during the 5-year study period, with an age-standardised annual incidence (ASR) of 5.24 per 100,000 (95% CI: 5.02, 5.45). Similar numbers of adenocarcinoma and squamous cell carcinoma were found. Only 152 (5.6%) had no histology. There was a 5-fold difference in age-standardised annual incidence rates between males and females for adenocarcinoma of oesophagus, but no gender difference for squamous cell carcinoma. The parallel but higher ASR in males compared to females for adenocarcinoma of both oesophagus and cardia merits further investigation. The similarities in the patterns of age- and sex-specific rates and in the socioeconomic profiles could indicate a common aetiology for adenocarcinoma of oesophagus and gastric cardia. Quality control in Cancer Registries needs to focus on the accuracy and consistency of subsite classification to ensure that trends in incidence are identified. In the absence of accurate subsite classification of stomach cancers, the proportions of adenocarcinoma and squamous cell carcinoma of oesophagus (or the absolute rate of adenocarcinoma of oesophagus) may provide a useful tool in indicating whether adenocarcinoma of gastric cardia is likely to be increasing in incidence.
Article
To prospectively assess the influence of body mass index (BMI), tobacco, and alcohol on the occurrence of esophageal, gastric cardia, and non-cardia gastric adenocarcinoma, and to detect any sex differences that could explain the male predominance of these tumors. A case-control study nested in the General Practitioner Research Database in the United Kingdom, 1994--2001. Odds ratios (ORs) were calculated with 95% confidence intervals (CI), including multivariate analysis. During follow-up of 4,340,207 person-years, we identified 287 esophageal adenocarcinomas, 195 gastric cardia adenocarcinomas, 327 gastric non-cardia adenocarcinomas, and 10,000 controls. A positive association was found between overweight (BMI > 25 kg/m(2)) and esophageal adenocarcinoma (OR 1.67, 95% CI 1.22--2.30), and gastric cardia adenocarcinoma (OR 1.46, 95% CI 0.98--2.18), but not non-cardia gastric adenocarcinoma. The association between BMI and esophageal and gastric cardia adenocarcinoma were dose-dependent and seemingly independent of reflux. No strong sex differences were identified. Smokers, particularly females, were at increased risk of all studied adenocarcinomas, while no association with alcohol was found. Overweight increases risk of esophageal and gastric cardia adenocarcinoma, while tobacco smoking increases risk of esophageal, gastric cardia, and non-cardia gastric adenocarcinoma. The male predominance is not explained by sex differences in risk factor profiles of the studied exposures.
Article
The prevalence of gastro-oesophageal reflux disease is thought to be rising but supporting evidence is sparse. We assessed trends from data prospectively collected over 25 years at our centre which serves Rotherham's 250000 population. Detailed computerised records have been kept of all patients investigated for upper gastrointestinal symptoms. Erosive oesophagitis=endoscopy-verified erosive changes. Non-erosive reflux=heartburn+/-regurgitation but normal endoscopy. Gastro-oesophageal reflux disease=erosive oesophagitis+non-erosive reflux, i.e. total. The data, presented in 5-year time periods spanning 1977-2001, showed four major changing trends. (1) The numbers with newly diagnosed gastro-oesophageal reflux disease rose markedly, affecting both erosive oesophagitis and non-erosive reflux. Gastro-oesophageal reflux disease: n=714; 1587; 2381; 3812; 3880. (2) The proportion of women affected rose from 0.36 to 0.82. (3) Gastro-oesophageal reflux disease patients were older than the general population; the mean age at presentation rose from 48.0 to 53.5 years. (4) Presentation with haemorrhage (percentage of erosive oesophagitis) rose from 5.2% to 10.9% but, as with stricture (around 4%), remained uncommon. Throughout, few (4.4%) changed from non-erosive reflux to erosive oesophagitis. The marked increase in gastro-oesophageal reflux disease cannot be accounted for by greater awareness alone for the demographic profile has changed, or by misclassification as erosive oesophagitis was diagnosed on endoscopic appearances. The dramatic five-fold increase in gastro-oesophageal reflux disease is a new phenomenon, perhaps an example of a disease in evolution.
Article
To assess quality of life (QoL) and symptoms after oesophageal cancer surgery, a prospective nationwide population-based study was conducted in 2001-2005, including most surgically treated oesophageal cancer patients in Sweden. Six months postoperatively patients responded to an EORTC quality of life core questionnaire (QLQ C-30) with an oesophageal-specific module (OES-18). Mean scores were calculated. Mann-Whitney test was used for group comparisons. Among 282 patients, QoL was considerably reduced compared to a reference general population (P<0.001), and functioning scales were similarly negatively affected; particularly role (P<0.001) and social (P<0.001) functions. Younger patients scored worse than older. No gender differences were found. Dominating general symptoms included fatigue, appetite loss, diarrhoea, and dyspnoea, each significantly more pronounced than the general population (P<0.001). Eating problems, cough, reflux, and oesophageal pain were common oesophageal-specific symptoms. Thus, patients who undergo oesophageal cancer resection suffer greatly from reduced QoL and several general and oesophageal-specific symptoms six months postoperatively.