Abstract
Helicobacter pylori (H.pylori) is associated with lower risks of Barrett's esophagus and esophageal adenocarcinoma, but whether H.pylori eradication increases the risk of these conditions is unknown. This study aimed to test the hypothesis that H.pylori eradication leads to gradually increased risks of Barrett's esophagus and esophageal adenocarcinoma over time, while esophageal squamous cell carcinoma was assessed for comparison reasons. This Swedish nationwide, population-based cohort study in 2005-2012 used data from the Swedish Prescribed Drug Registry to assess eradication treatment for H.pylori. Barrett's esophagus was identified from the Swedish Patient Registry, and esophageal adenocarcinoma and squamous cell carcinoma from the Swedish Cancer Registry. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by dividing the observed risk in the H.pylori eradication treatment cohort by the expected risk derived from the Swedish population of the same age, sex, and calendar period. The cohort included 81919 patients having had eradication treatment. For Barrett's esophagus (n=178), the overall SIR was increased (SIR 3.67, 95% CI 3.15-4.25), but the SIRs slightly decreased over time after eradication treatment. For esophageal adenocarcinoma (n=11), the overall SIR was 1.26 (95% CI 0.62-2.26), and the SIRs did not increase over time. The SIRs of esophageal squamous cell carcinoma (n=10) were not influenced by eradication treatment. This study did not provide any evidence of an increasing risk of Barrett's esophagus or esophageal adenocarcinoma (or esophageal squamous cell carcinoma) over time after eradication treatment for H.pylori.
Highlights
The incidence of esophageal adenocarcinoma has increased markedly in Western countries since the 1970s.1 In most Western countries, the incidence of esophageal adenocarcinoma has surpassed that of esophageal squamous cell carcinoma, which is the most common histologic type of esophageal cancer globally.[2]
For esophageal adenocarcinoma and its precursor lesion Barrett's esophagus, the main risk factors are gastroesophageal reflux disease (GERD) and obesity, while presence of Helicobacter pylori (H. pylori) in the stomach is associated with a 32%-56% decreased risk of Barrett's esophagus,[3] and a 36%-44% decreased risk of esophageal adenocarcinoma.[3]
Ten out of 11 cases of esophageal adenocarcinoma were detected in participants with 1 prescribed eradication treatment (SIR 1.28, 95% confidence intervals (CIs) 0.61-2.36)
Summary
The incidence of esophageal adenocarcinoma has increased markedly in Western countries since the 1970s.1 In most Western countries (including Sweden), the incidence of esophageal adenocarcinoma has surpassed that of esophageal squamous cell carcinoma, which is the most common histologic type of esophageal cancer globally.[2]. In most Western countries (including Sweden), the incidence of esophageal adenocarcinoma has surpassed that of esophageal squamous cell carcinoma, which is the most common histologic type of esophageal cancer globally.[2] For esophageal adenocarcinoma and its precursor lesion Barrett's esophagus, the main risk factors are gastroesophageal reflux disease (GERD) and obesity, while presence of Helicobacter pylori (H. pylori) in the stomach is associated with a 32%-56% decreased risk of Barrett's esophagus,[3] and a 36%-44% decreased risk of esophageal adenocarcinoma.[3] These inverse associations with H. pylori are thought to be the result of H. pylori-associated gastric atrophy, which leads to lower gastric acid production and lower prevalence of GERD It is not studied if eradication treatment for H. pylori increases the risks of Barrett's esophagus or esophageal adenocarcinoma. Conclusions: This study did not provide any evidence of an increasing risk of Barrett's esophagus or esophageal adenocarcinoma (or esophageal squamous cell carcinoma) over time after eradication treatment for H. pylori
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