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Mortality in gastro-oesophageal reflux disease in a population-based nationwide cohort study of Swedish twins.

ABSTRACT: OBJECTIVES:The public health disorder gastro-oesophageal reflux disease (GORD) is linked with several comorbidities, including oesophageal adenocarcinoma (OAC), but whether life expectancy is reduced by GORD is uncertain. This study assessed all-cause and cancer-specific mortality in GORD after controlling for confounding by heredity and other factors. DESIGN:Population-based cohort study from 1998 to 2015. SETTING:Swedish nationwide study. PARTICIPANTS:Twins (n=40?961) born in 1958 or earlier in Sweden. EXPOSURE:GORD symptoms reported in structured computer-assisted telephone interviews. OUTCOMES:The primary outcome was all-cause mortality and the secondary outcome was cancer-specific mortality among twins with GORD and twins without GORD. HRs and 95% CIs were analysed using parametric survival models, both in individual twin analyses and co-twin pair analyses, with adjustment for body mass index, smoking, education and comorbidity. RESULTS:Among 40?961 individual twins, 5812 (14.2%) had GORD at baseline and 8062 (19.7%) died during follow-up of up to 16 years. The risks of all-cause mortality (HR=1.00, 95%?CI: 0.94-1.07) and cancer-specific mortality (HR=0.99, 95%?CI: 0.89-1.10) were not increased in individual twins with GORD compared with individual twins without GORD. Similarly, there were no differences in mortality outcomes in within-pair analyses. The OAC-specific mortality rate was 0.45 (95% CI: 0.32-0.66) per 1000 person-years in individual twins with GORD and 0.22 (95% CI: 0.18-0.27) per 1000 person-years without GORD, rendering an adjusted HR of 2.01 (95% CI: 1.35-2.98). CONCLUSIONS:GORD did not increase all-cause or cancer-specific mortality when taking heredity and other confounders into account. The increased relative risk of mortality in OAC was low in absolute numbers.

SUBMITTER: Ness-Jensen E

PROVIDER: S-EPMC7412590 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Mortality in gastro-oesophageal reflux disease in a population-based nationwide cohort study of Swedish twins.

Ness-Jensen Eivind E Santoni Giola G Gottlieb-Vedi Eivind E Lindam Anna A Pedersen Nancy N Lagergren Jesper J

BMJ open 20200806 8

<h4>Objectives</h4>The public health disorder gastro-oesophageal reflux disease (GORD) is linked with several comorbidities, including oesophageal adenocarcinoma (OAC), but whether life expectancy is reduced by GORD is uncertain. This study assessed all-cause and cancer-specific mortality in GORD after controlling for confounding by heredity and other factors.<h4>Design</h4>Population-based cohort study from 1998 to 2015.<h4>Setting</h4>Swedish nationwide study.<h4>Participants</h4>Twins (n=40 9 ...[more]

PMID: 32764086

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Project description:ObjectiveTo assess the incidence rate of oesophageal adenocarcinoma among patients with non-erosive gastro-oesophageal reflux disease compared with the general population.DesignPopulation based cohort study.SettingAll patients in hospital and specialised outpatient healthcare in Denmark, Finland, and Sweden from 1 January 1987 to 31 December 2019.Participants486 556 adults (>18 years) who underwent endoscopy were eligible for inclusion: 285 811 patients were included in the non-erosive gastro-oesophageal reflux disease cohort and 200 745 patients in the validation cohort with erosive gastro-oesophageal reflux disease.ExposuresNon-erosive gastro-oesophageal reflux disease was defined by an absence of oesophagitis and any other oesophageal diagnosis at endoscopy. Erosive gastro-oesophageal reflux disease was examined for comparison reasons and was defined by the presence of oesophagitis at endoscopy.Main outcome measuresThe incidence rate of oesophageal adenocarcinoma was assessed for up to 31 years of follow-up. Standardised incidence ratios with 95% confidence intervals were calculated by dividing the observed number of oesophageal adenocarcinomas in each of the gastro-oesophageal reflux disease cohorts by the expected number, derived from the general populations in Denmark, Finland, and Sweden of the corresponding age, sex, and calendar period.ResultsAmong 285 811 patients with non-erosive gastro-oesophageal reflux disease, 228 developed oesophageal adenocarcinomas during 2 081 051 person-years of follow-up. The incidence rate of oesophageal adenocarcinoma in patients with non-erosive gastro-oesophageal reflux disease was 11.0/100 000 person-years. The incidence was similar to that of the general population (standardised incidence ratio 1.04 (95% confidence interval 0.91 to 1.18)), and did not increase with longer follow-up (1.07 (0.65 to 1.65) for 15-31 years of follow-up). For validity reasons, we also analysed people with erosive oesophagitis at endoscopy (200 745 patients, 1 750 249 person-years, and 542 oesophageal adenocarcinomas, corresponding to an incidence rate of 31.0/100 000 person-years) showing an increased overall standardised incidence ratio of oesophageal adenocarcinoma (2.36 (2.17 to 2.57)), which became more pronounced with longer follow-up.ConclusionsPatients with non-erosive gastro-oesophageal reflux disease seem to have a similar incidence of oesophageal adenocarcinoma as the general population. This finding suggests that endoscopically confirmed non-erosive gastro-oesophageal reflux disease does not require additional endoscopic monitoring for oesophageal adenocarcinoma.

Dataset Information

Mortality in gastro-oesophageal reflux disease in a population-based nationwide cohort study of Swedish twins.

Publications

Mortality in gastro-oesophageal reflux disease in a population-based nationwide cohort study of Swedish twins.

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