Maret-Ouda J, et al. – Researchers conducted this multinational, population-based, retrospective cohort study to determine if antireflux surgery is related to decreased risk of esophageal adenocarcinoma, and assess whether the risk is different between surgically and medically treated patients. Findings suggested an association of medical and surgical treatment of gastroesophageal reflux disease (GERD) with a comparable reduced esophageal adenocarcinoma risk, with the risk decreasing to the same level as that in the background population over time, supporting the premise that effective treatment of GERD might prevent esophageal adenocarcinoma.

Methods

• In this study from Denmark, Finland, Iceland, Norway, and Sweden, patients undergoing surgery were followed up for a median of 12.7 years, and a comparison group of patients receiving medication only were followed up for a median of 4.8 years.
• Study participants included all patients with a registered diagnosis of GERD (or an associated disorder), including 48,414 individuals undergoing surgery and 894,492 receiving medication only.
• From January 1, 1964, to December 21, 2014, the study periods differed in the different countries depending on the year of initiation of registration and the date of data retrieval.
• Antireflux surgery for GERD was the main exposure.
• Researchers compared the risk of esophageal adenocarcinoma over time after surgery with that in a corresponding background population utilizing standardized incidence ratios (SIRs) with 95% confidence intervals and with patients with GERD who received medication utilizing multivariable Cox proportional hazards regression, providing hazard ratios with 95% confidence intervals adjusted for confounders.

Results

• According to the findings, 48,414 patients had antireflux surgery and 894,492 received medication only in this study of 942,906 patients with GERD.
• A total of 177 patients developed esophageal adenocarcinoma among patients undergoing surgery.
• Compared with the background population, esophageal adenocarcinoma risk decreased in a time-dependent manner after surgery.
• The SIRs were 10.08 (95% CI: 6.98-14.09) at 5 to < 10 years after surgery and 1.67 (95% CI, 1.15-2.35) at ≥ 15 years after surgery among patients with more severe and objectively determined GERD.
• Compared with patients who received medication only, the risk of esophageal adenocarcinoma did not change over time in surgical patients.
• In analyses restricted to severe reflux disease, the risk remained stable over time.