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Background: 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. Material and Methods: 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. Results: The cohort included 81 919 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. 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. [ABSTRACT FROM AUTHOR]

Background: The presence of distinct long‐term disease‐specific HRQL trajectories after curative treatment for esophageal cancer and factors associated with such trajectories are unclear. Materials and Methods: This population‐based and longitudinal cohort study included 425 esophageal cancer patients who underwent curative treatment, including esophagectomy, in Sweden in 2001–2005 and were followed up until 2020, that is, 15‐year follow‐up. The outcomes were 10 disease‐specific HRQL symptoms, measured by the well‐validated EORTC QLQ‐OES18 questionnaire at 6 months (n = 402 patients), and 3 (n = 178), 5 (n = 141), 10 (n = 92), and 15 years (n = 52) after treatment. HRQL symptoms were examined for distinct trajectories by growth mixture models. Weighted logistic regression models provided odds ratios (OR) with 95% confidence intervals (95% CI) for nine factors in relation to HRQL trajectories: age, sex, education, proxy baseline HRQL, comorbidity, tumor histology, chemo(radio)therapy, pathological tumor stage, and postoperative complications. Results: Distinct HRQL trajectories were identified for each of the 10 disease‐specific symptoms. HRQL trajectories with more symptoms tended to persist or alleviate over time, while trajectories with fewer symptoms were more stable. Eating difficulty had three trajectories: persistently less, persistently moderate, and persistently more symptoms. The OR of having a persistently more eating difficulty trajectory was decreased for adenocarcinoma histology (OR = 0.44, 95% CI 0.21–0.95), and increased for pathological tumor stage III‐IV (OR = 2.19, 95% CI 0.99–4.82) and 30‐day postoperative complications (OR = 2.54, 95% CI 1.26–5.12). Conclusion: Distinct trajectories with long‐term persistent or deteriorating disease‐specific HRQL symptoms were identified after esophageal cancer treatment. Tumor histology, tumor stage, and postoperative complications may facilitate detection of high‐risk patients for unwanted trajectories. [ABSTRACT FROM AUTHOR]

It is unclear how increasing body mass index (BMI) influences risk of cancer in young women. We used data from the Medical Birth, Patient and Cause of Death registers collected between 1982 and 2014 to determine the risk of obesity-related cancer types, breast cancer, all cancer and cancer-related death in relation to BMI in 1,386,725 women, aged between 18 and 45 years, in Sweden. During a median follow-up of 16.3 years (IQR 7.7–23.5), 9808 women developed cancer. The hazard ratio (HR) of endometrial and ovarian cancer increased with higher BMI from 1.08 (95% CI 0.93–1.24) and 1.08 (95% CI 0.96–1.21) among women with BMI 22.5–< 25 to 2.33 (95% CI 1.92–2.83) and 1.48 (95% CI 1.24–1.77), respectively, among women with BMI ≥ 30. There were linear and positive associations between BMI and incident cancer in the ovary, colon, endometrium, pancreas, rectum, gallbladder, esophageal cancer and renal cell carcinoma, as well as death from obesity-related cancer forms. In conclusion, we found that elevated BMI in young women linearly associated with several obesity-related cancer forms, including death from these cancers. [ABSTRACT FROM AUTHOR]

Oesophageal cancer is a clinically challenging disease that requires a multidisciplinary approach. Extensive treatment might be associated with a considerable decline in health-related quality of life and yet still a poor prognosis. In recent decades, prognosis has gradually improved in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. Several therapeutic alternatives are available for palliative treatment. This Seminar aims to provide insights into the current clinical management, ongoing controversies, and future needs in oesophageal cancer. [ABSTRACT FROM AUTHOR]

Objectives:Helicobacter pyloriis associated with peptic ulcers and gastric cancer and its eradication aims to prevent these conditions. The recommended eradication regimen is triple therapy, consisting of a proton-pump inhibitor in combination with clarithromycin and amoxicillin or metronidazole for 7 days. Yet, other antibiotic regimens are sometimes prescribed. We aimed to assess the use of eradication therapy forH. pyloriin the Swedish population during the last decade. Materials and methods:This population-based study used data from the Swedish Prescribed Drug Register. From July 2005 until December 2014, all regimens that can eradicateH. pyloriwere identified and evaluated according to patients’ age and sex and calendar year of eradication. Results:We identified 157,915 eradication episodes in 140,391 individuals (53.8% women, 42.6% older than 60 years), who correspond to 1.5% of the Swedish population. The absolute number and incidence of eradications decreased over the study period. Overall, 91.0% had one eradication and 0.1% had more than three. Of all eradications, 95.4% followed the recommended regimen, while 4.7% did not. The latter group was overrepresented among individuals aged ≥80 years (7.8%). Amoxicillin and clarithromycin were most frequently prescribed, while metronidazole was rarely used (0.01%). Other prescribed antibiotics were ciprofloxacin (2.4%), doxycycline (1.4%), nitrofurantoin (0.7%), norfloxacin (0.5%) and erythromycin (0.3%). Conclusions:During the last decade in SwedenH. pylorieradication has been frequently prescribed, but the incidence of eradication has slowly declined. Most eradications followed the recommended regimen, including those occurring after a previous eradication. [ABSTRACT FROM PUBLISHER]

Background:Psychological distress is common among patients with oesophageal cancer. However, little is known about the course and predictors of psychological distress among patients treated with curative intent. Therefore, the aim of this study was to explore the prevalence, course and predictors of anxiety and depression in patients operated for oesophageal cancer, from prior to surgery to 12 months post-operatively. Methods:A prospective cohort of patients with oesophageal cancer (n = 218) were recruited from one high-volume specialist oesophago-gastric treatment centre (St Thomas’ Hospital, London, UK). Anxiety and depression were assessed prior to surgery, 6 and 12 months post-operatively. Mixed-effects modelling was performed to investigate changes over time and to estimate the association between clinical and socio-demographic predictor variables and anxiety and depression symptoms. Results:The proportion of patients with anxiety was 33% prior to surgery, 28% at 6 months, and 37% at 12 months. Prior to surgery, 20% reported depression, 27% at 6 months, and 32% at 12-month follow-up. Anxiety symptoms remained stable over time whereas depression symptoms appeared to increase from pre-surgery to 6 months, levelling off between 6 and 12 months. Younger age, female sex, living alone and more severe self-reported dysphagia (i.e., difficulty swallowing) predicted higher anxiety symptoms. In-hospital complications, greater limitations in activity status and more severe self-reported dysphagia were predictive of higher depression. Conclusions:Many patients report psychological distress during the first year following oesophageal cancer surgery. Whether improving the experience of swallowing difficulties may also reduce distress among these patients warrants further study. [ABSTRACT FROM AUTHOR]

Dear Editor, We are grateful for the interest in our study examining how discontinuation of long-term use of a proton-pump inhibitor (PPI) influences risk of developing gastric and oesophageal adenocarcinoma. We agree that the biological mechanisms linking PPI use with an increased risk of oesophageal adenocarcinoma is more farfetched than that for gastric adenocarcinoma, and that confounding by indication in particular is a concern in observational research. [Extracted from the article]

The best available surgical strategy in the treatment of resectable esophago-gastric junctional (EGJ) cancer is a controversial topic. In this review we evaluate the current literature and scientific evidence examining the surgical treatment of locally advanced EGJ cancer by comparing esophagectomy with gastrectomy, transhiatal with transthoracic esophagectomy, minimally invasive with open esophagectomy, and less extensive with more extensive lymphadenectomy. We also assess endoscopic procedures increasingly used for early EGJ cancer. The current evidence does not favor any of the techniques over the others in terms of oncological outcomes. Health-related quality of life may be better following gastrectomy compared to esophagectomy. Minimally invasive procedures might be less prone to surgical complications. Endoscopic techniques are safe and effective alternatives for early-stage EGJ cancer in the short term, but surgical treatment is the mainstay in fit patients due to the risk of lymph node metastasis. Any benefit of lymphadenectomy extending beyond local or regional nodes is uncertain. This review demonstrates the great need for well-designed clinical studies to improve the knowledge in how to optimize and standardize the surgical treatment of EGJ cancer. [ABSTRACT FROM AUTHOR]

Purpose To determine whether oesophageal cancer survivors recover in health-related quality of life (HRQOL) within 10 years of surgery. Methods A prospective, nationwide, population-based cohort study including 90% of all oesophageal cancer surgery patients in Sweden in 2001–2005, with follow-up through 2015. HRQOL was assessed 5 and 10 years postoperatively, using questionnaires for cancer in general (EORTC QLQ-C30) and oesophageal cancer specifically (EORTC QLQ-OES18). The HRQOL measures at 10 years after surgery were compared with the 5-year assessment. The 10-year HRQOL scores were compared with a population-based reference population (4910 individuals), individually matched for age, sex and comorbidity, by means of mean score differences with 95% confidence intervals. Results Among 616 patients, 104 (17%) survived at least 10 years. Of these, 92 (88%) responded to the HRQOL questionnaires at 5 and 10 years after surgery. Among the responders, 71% were older than 70 years. Patients did not improve in HRQOL between 5 and 10 years. Instead, the scores for 23 out of 25 HRQOL aspects declined, with clinically relevant and statistically significant deterioration in role function and appetite loss. Compared to the reference population, the 10 year-survivors had worse scores in all 25 HRQOL aspects, with significant deterioration in global quality of life, role functioning, social functioning and most symptoms. The most severe problems compared to the reference population were reflux, eating difficulties, diarrhoea and appetite loss. Conclusion Patients who have undergone curative treatment for oesophageal cancer experience reduced HRQOL with persisting symptoms 10 years after surgery. [ABSTRACT FROM AUTHOR]

Objective: We aimed to assess temporal trends in incidence rates of oesophageal cancer in Asian countries.Materials and Methods: Using data from the Cancer Incidence in Five Continents series, we examined the temporal trends in incidence rates of oesophageal cancer by population and histological type in seven Asian countries in 1988-2007. Age-period-cohort analyses estimated the overall annual percentage changes (net drifts) and their 95% confidence intervals (CIs) in incidence rates.Results: The age-standardised incidence rate of oesophageal cancer declined in most Asian populations, but remained relatively unchanged in Japan and Israel. The rate of oesophageal squamous cell carcinoma decreased in Hong Kong, Singapore and Israel, but was stable in Japan. The net drifts were statistically significant in men in Hong Kong (-3.4%, 95% CI: -6.1%, -0.7%) and in women in Singapore (-10.1%, 95% CI: -14.4%, -5.5%). The age-standardised incidence rates of oesophageal adenocarcinoma were below 2 and 0.5 per 100 000 in men and women, respectively, across all periods in the all registers containing valid data on histological type. The age-standardised incidence rate of oesophageal adenocarcinoma slightly increased in Japan, Singapore, and Israel, although the net drift was statistically significant only in Israeli men (4.9%, 95% CI: 0.8%, 9.1%).Conclusion: The overall incidence rates of oesophageal cancer declined in most Asian countries, which is due to a decrease in oesophageal squamous cell carcinoma incidence. However, attention needs to be paid to a probable beginning of an increasing incidence of oesophageal adenocarcinoma in Asia. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori (H. pylori) is associated with an increased risk of gastric adenocarcinoma and gastric mucosa associated lymphoid tissue (MALT) lymphoma and a decreased risk of esophageal adenocarcinoma. We aimed to assess how eradication therapy for H. pylori influences the risk of developing these cancers.Methods: This was a systematic review and meta-analysis. We searched PubMed, Web of Science, Embase, and the Cochrane Library and selected articles that examined the risk of gastric cancer, MALT lymphoma, or esophageal cancer following eradication therapy, compared with a noneradicated control group.Results: Among 3629 articles that were considered, nine met the inclusion criteria. Of these, eight cohort studies assessed gastric cancer while one randomized trial assessed esophageal cancer. Out of 12 899 successfully eradicated patients, 119 (0.9%) developed gastric cancer, compared with 208 (1.1%) out of 18 654 noneradicated patients. The pooled relative risk of gastric cancer in all eight studies was 0.46 (95% confidence interval [CI] = 0.32 to 0.66, I(2) = 32.3%) favoring eradication therapy. The four studies adjusting for time of follow-up and confounders showed a relative risk of 0.46 (95% CI = 0.29 to 0.72, I(2) = 44.4%).Conclusions: This systematic review and meta-analysis indicates that eradication therapy for H. pylori prevents gastric cancer. There was insufficient literature for meta-analysis of MALT lymphoma or esophageal cancer. [ABSTRACT FROM AUTHOR]

Objective: The phase angle identifies changes in tissue’s electrical properties assessed by bioelectrical impedance measurement and it can predict prognosis in some conditions. Percutaneous endoscopic gastrostomy (PEG) is commonly used in patients with severe nutritional problems, but there is a need to improve the clinical decision-making for using PEG. We examined if a decreased phase angle predicts complications, short-term mortality (within 60 days of PEG insertion), or inflammatory markers (high C-reactive protein [CRP] levels or low albumin levels) following PEG insertion. Material and methods: The phase angle was assessed from body resistance and reactance as measured by bioelectrical impedance in 131 patients admitted for PEG. Anthropometrics and clinical biochemical measures were collected at the time of PEG insertion, while complications and mortality were assessed at clinical follow-ups. Multivariable logistic regression analysis provided odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for sex, age, body mass index, and comorbidity. Results: A decreased phase angle did not statistically significantly increase the probability of acute complications or short-term mortality, but predicted increased inflammatory markers (CRP ≥10 mg/L [OR 1.63, 95% CI 1.02–2.60], albumin <30 g/L [OR 2.10, 95% CI 1.24–3.57] and a combination of CRP ≥10 mg/L and albumin <30 g/L [OR 3.06, 95% CI 1.51–6.19]). Conclusions: A decreased phase angle did not predict acute complications or short-term mortality after PEG insertion, but predicted increased levels of inflammatory markers. [ABSTRACT FROM PUBLISHER]

Background: Marital status, income, and education might influence the risk of esophageal and gastric cancer, but the literature is limited. A large study addressing subtypes of these tumors was used to clarify these associations.Methods: A nationwide, Swedish population-based cohort study from 1991 to 2010 included individuals who were 50 years old or older. Data on exposures, covariates, and outcomes were obtained from well-maintained registers. Four esophagogastric tumor subtypes were analyzed in combination and separately: esophageal adenocarcinoma, esophageal squamous cell carcinoma, cardia adenocarcinoma, and noncardia gastric adenocarcinoma. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and adjusted for confounders.Results: Among 4,734,227 participants (60,634,007 person-years), 24,095 developed esophageal or gastric cancer. In comparison with individuals in a long marriage, increased IRRs were found among participants who were in a shorter marriage or were never married, remarried, divorced, or widowed. These associations were indicated for each tumor subtype but were generally stronger for esophageal squamous cell carcinoma. Higher education and income were associated with decreased IRRs in a seemingly dose-response manner and similarly for each subtype. In comparison with the completion of only primary school, higher tertiary education rendered an IRR of 0.64 (95% CI, 0.60-0.69) for men and an IRR of 0.68 (95% CI, 0.61-0.75) for women. Comparing participants in the highest and lowest income brackets (highest 20% vs lowest 20%) revealed an IRR of 0.74 (95% CI, 0.70-0.79) for men and an IRR of 0.83 (95% CI, 0.76-0.91) for women.Conclusions: Divorce, widowhood, living alone, low educational attainment, and low income increase the risk of each subtype of esophageal and gastric cancer. These associations require attention when high-risk individuals are being identified. Cancer 2016;122:207-212. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

We hypothesised that the use of the anti-androgenic drug 5α-reductase inhibitors (5-ARIs) improves survival in patients with oesophago-gastric cancer. This nationwide Swedish population-based cohort study included men who underwent surgery for oesophageal or gastric cancer between 2006-2015, with follow-up until the end of 2020. Multivariable Cox regression estimated hazard ratios (HR) for associations between 5-ARIs use and 5-year all-cause mortality (main outcome) and 5-year disease-specific mortality (secondary outcome). The HR was adjusted for age, comorbidity, education, calendar year, neoadjuvant chemo(radio)therapy, tumour stage, and resection margin status. Among 1769 patients with oesophago-gastric cancer, 64 (3.6%) were users of 5-ARIs. Compared to non-users, users of 5-ARIs were not at any decreased risk of 5-year all-cause mortality (adjusted HR 1.13, 95% CI 0.79-1.63) or 5-year disease-specific mortality (adjusted HR 1.10, 95% CI 0.79-1.52). Use of 5-ARIs was not associated with any decreased risk of 5-year all-cause mortality in subgroup analyses stratified by categories of age, comorbidity, tumour stage, or tumour subtype (oesophageal or cardia adenocarcinoma, non-cardia gastric adenocarcinoma, or oesophageal squamous cell carcinoma). This study did not support the hypothesis of improved survival among users of 5-ARIs after curatively intended treatment for oesophago-gastric cancer. [ABSTRACT FROM AUTHOR]

Objective This study assessed the associations between hospital volume, resection rate and survival of oesophageal and gastric cancer patients in England. Design 62 811 patients diagnosed with oesophageal or gastric cancer between 2004 and 2008 were identified from a national population-based cancer registration and Hospital Episode Statistics-linked dataset. Cox regression analyses were used to assess all-cause mortality according to hospital volume and resection rate, adjusting for case-mix variables (sex, age, socioeconomic deprivation, comorbidity and type of cancer). HRs and 95% CIs, according to hospital volume, were evaluated for three predefined periods following surgery: <30, 30-365, and >365 days. Analysis of mortality in relation to resection rate was performed among all patients and among the 13 189 (21%) resected patients. Results Increasing hospital volume was associated with lower mortality (ptrend=0.0001; HR 0.87, 95% CI 0.79 to 0.95 for hospitals resecting 80+ and compared with <20 patients a year). In relative terms, the association between increasing hospital volume and lower mortality was particularly strong in the first 30 days following surgery (ptrend<0.0001; HR 0.52, (0.39 to 0.70)), but a clinically relevant association remained beyond 1 year (ptrend=0.0011; HR 0.82, (0.72 to 0.95)). Increasing resection rates were associated with lower mortality among all patients (ptrend<0.0001; HR 0.86, (0.84 to 0.89) for the highest, compared with the lowest resection quintile). Conclusions With evidence of lower short-term and longer-term mortality for patients resected in high-volume hospitals, this study supports further centralisation of oesophageal and gastric cancer surgical services in England. [ABSTRACT FROM AUTHOR]

Background: Survival trends in oesophageal and gastric cancer need to be updated. A nationwide Swedish populationbased study in 1961-2009 was based on registry data. Methodology/Principal Findings: Relative survival rate, i.e. the ratio of the observed to the expected survival, adjusted for age, sex, and calendar period, and presented with 95% confidence intervals (CI), was the main outcome measure. The expected survival was calculated using the corresponding Swedish general population with no exclusions. The relative survival rates in oesophageal and gastric cardia adenocarcinoma have improved since the 1990s (p for trend <0.001), but not in oesophageal squamous cell carcinoma or gastric non-cardia adenocarcinoma. The relative 5-year survival rates during the two recent periods 1990-1999 and 2000-2008 were 12.5% (95%CI 10.1%-14.9%) and 10.3% (95%CI 8.5-12.0%) for oesophageal squamous cell carcinoma, 12.5% (95%CI 10.1%-14.9%) and 14.6% (95%CI 12.6-16.6%) for oesophageal adenocarcinoma, 11.1% (95%CI 9.6%-12.6%) and 14.3% (95%CI 12.3-16.3%) for gastric cardia adenocarcinoma, and 20.2% (95%CI 19.2%-21.1%) and 19.0% (95%CI 17.7-20.2%) for gastric non-cardia adenocarcinoma. The 3-year survival in tumour stage III in 2004-2008 was about 25% for all four tumour types. Conclusions/Significance: The survival in oesophageal and cardia adenocarcinoma is increasing, but the lack of such increase in oesophageal squamous cell carcinoma and gastric non-cardia adenocarcinoma is a concern. [ABSTRACT FROM AUTHOR]

Background. Insertion of a percutaneous endoscopic gastrostomy (PEG) is an increasingly common procedure in patients with nutritional needs and dysphagia. Better knowledge of rates and patterns of complications after PEG might influence decision-making. Material and methods. The objective was to prospectively evaluate the rate of six pre-defined complications (leakage, diarrhea, constipation, abdominal pain, fever and peristomal infection) and mortality occurring within 2 months after PEG in an unselected sample of patients. All patients ( n = 484) who had a PEG inserted at the hospital during the study period were included. Kaplan-Meier curves were used to estimate mortality over the first 60 days following PEG and Fisher's exact test was used to test equality of proportions. Results. Of the 484 patients included, 85 (18%) died within 2 months after PEG insertion. The risk of early mortality was higher in the group with neurological disease than in the group with a tumor as indication (p < 0.001). After excluding mortality, the overall complication rates at 2 weeks and 2 months were 39% and 27%, respectively. The most common complications within 2 weeks were abdominal pain (13%), peristomal infection (11%), diarrhea (11%) and leakage (10%). At 2 months the most frequent complications were diarrhea (10%), leakage (8%) and peristomal infection (6%). Conclusions. In the short-term perspective, there is a substantial risk of complications, including mortality, after PEG insertion. This should be considered during clinical decision-making and when informing the patients and caregivers. [ABSTRACT FROM AUTHOR]

Objective To evaluate the suggested association between tetracycline and acute pancreatitis in a large pharmacoepidemiological study. Design The use of tetracycline in relation to the risk of acute pancreatitis was examined in a nationwide caseecontrol study of people aged 40e84 years between 2006 and 2008 in Sweden. The Swedish Patient Register was used to identify 6161 cases of firstepisode acute pancreatitis. The Register of the Total Population was used to randomly select 61 637 control subjects from the general population using frequencybased density sampling, matched for age, sex, and calendar year. Tetracycline use was defined as 'current', 'recent', 'past' or 'former' if the drug had been dispensed 0e30 days, 31e180 days, 181e365 days or 1e3½ years before the index date, respectively. The risk of acute pancreatitis was estimated by unconditional logistic regression, providing ORs with 95% CIs, adjusted for potential confounding factors. Results There was a 60% increased risk of acute pancreatitis among current users of tetracycline after adjustment for potential confounders (OR=1.6, 95% CI 1.2 to 2.1). There was no increased OR for any category of previous use. Conclusion Current use of tetracycline is associated with an increased risk of acute pancreatitis, verifying previous case reports. INSET: Significance of this study. [ABSTRACT FROM AUTHOR]

Abstract: Background: The influence of bile reflux in the development of oesophageal adenocarcinoma remains controversial. This was tested in a cohort of patients who had undergone gastrectomy, a procedure often entailed by substantial bile reflux. Methods: A population-based cohort study of patients who had undergone gastrectomy for peptic ulcer disease in 1964–2008 in Sweden. Follow-up for cancer and censoring for death were achieved through linkages to nationwide registries of Cancer and Population, respectively. The number of observed cancer cases in the gastrectomy cohort was divided by the expected number, calculated from the incidence of the entire Swedish population of corresponding age, sex and calendar year. Relative risks were thus presented as standardised incidence ratios with 95% confidence intervals. Results: After exclusion of all person-years the first year after surgery, the final gastrectomy cohort comprised of 19,767 patients. These patients were followed up for a median of 17years, and contributed with a total of 348,231 person-years at risk. The observed number of patients with oesophageal adenocarcinoma (n =7) was not higher than the expected (n =11.6), providing a standardised incidence ratio of 0.6 (95%CI 0.2–1.2). There were no clear differences between sexes, age groups or latency intervals after gastrectomy. Conclusions: Gastrectomy for peptic ulcer disease does not appear to increase the risk of oesophageal adenocarcinoma. [Copyright &y& Elsevier]

Abstract: Objective: The introduction of motor vehicles in industrialised countries during the mid 20th century seems to fit with the increasing incidence and the strong male predominance of oesophageal adenocarcinoma. The aim of the study was to test this new hypothesis in a large case–control study. Methods: A nationwide, Swedish, population-based case–control study included 189 and 262 cases of oesophageal and cardia adenocarcinoma, respectively, 167 cases of oesophageal squamous-cell carcinoma and 820 frequency-matched controls during 1995–1997. Tumours were uniformly classified. Exposure data were collected at face-to-face interviews. Odds ratios (ORs), with 95% confidence intervals (CIs), were estimated and adjusted for confounding in multivariable logistic regression models. Results: There were no associations between regular contact with cars or airplanes regarding duration, frequency and age of contact and risk of oesophageal adenocarcinoma. The adjusted ORs for oesophageal adenocarcinoma, cardia adenocarcinoma and oesophageal squamous-cell carcinoma among persons spending at least two hours per day in cars were 1.3 (95%CI 0.7–2.3), 1.2 (95%CI 0.7–1.8), and 0.7 (95%CI 0.4–1.3), respectively. The corresponding ORs among frequent airplane passengers were 0.8 (95%CI 0.2–2.3), 1.1 (95%CI 0.5–2.2), and 0.9 (95%CI 0.3–2.5), respectively. Conclusion: This large, population based case–control study does not support the hypothesis that frequent contact with motor vehicles has contributed to the increasing incidence or the male predominance of oesophageal adenocarcinoma. [Copyright &y& Elsevier]

The article presents information on oesophageal cancer. It cites the two main histological types of oesophageal cancer, adenocarcinoma and squamous cell carcinoma. Progressive dysphagia and weight loss are considered the cardinal symptoms of the disease. Details on the primary and secondary prevention of the disease are discussed. The process of how oesophageal cancer is diagnosed are illustrated. It notes that surgical resection remains to be the main option for curative treatment. It reveals that during the past 20 years, the prognosis for patients with oesophageal cancer is improving.

Oesophageal cancer is an aggressive disease with a poor prognosis. Oesophagectomy is an established, potentially curative treatment, for patients with resectable oesophageal cancer. The anatomical location of the oesophagus explains why this type of operation is one of the most demanding and traumatic surgical procedures undertaken in general surgery. Unfortunately, the risk for severe post-operative complications is high and the chance for cure remains low. It is, however, encouraging that the post-operative morbidity has been decreasing and the survival has been improving during recent years. Several factors might have contributed to this improvement, including the centralization of oesophageal cancer surgery to high volume centres. This review focuses on the impact of hospital and surgeon volume on various outcomes after oesophagectomy for oesophageal cancer. Most available research indicates that, as far as post-operative complications, early post-operative mortality and health economics after oesophagectomy are concerned, high surgery volume is to be recommended, while the few studies evaluating long-term survival and health-related quality of life adjusted for tumour stage found no evidence of a role for volume. In conclusion, the available literature supports the centralization of oesophagectomy for cancer to dedicated centres with a multidisciplinary approach and a good track record of valid clinical research. [ABSTRACT FROM AUTHOR]

Abstract: Oesophageal cancer is the sixth most common form of cancer death globally with almost 400,000 deaths annually. More than 90% of all cases are either adenocarcinomas (OAC) or squamous-cell carcinomas (OSCC). There is a strong male predominance with up to 8 and 3 men for every woman affected with OAC and OSCC, respectively. It has been hypothesised that sex hormonal factors may play a role in the development of oesophageal cancer or more specifically that oestrogen prevents such development. This article reviews the available literature on this topic. Basic science studies suggest an inhibitory effect of oestrogen in the growth of oesophageal cancer cells, and a possible mechanism of any oestrogen protection might be mediated through oestrogen receptors. But from the few epidemiological studies in which the hypothesis of oestrogen protection has been tested, no firm conclusions can yet be drawn of the role of oestrogen in human oesophageal cancer aetiology. More evidence from valid and large human studies is needed before any conclusions can be drawn. [Copyright &y& Elsevier]

Abstract: Gastric cancer is the second most common cause of cancer death worldwide, and annually it causes over 150,000 deaths in Europe and 700,000 deaths globally. The incidence of gastric cancer shows an enigmatic male dominance with a male-to-female ratio of about 2:1. This sex ratio cannot be entirely attributed to the differences in the prevalence of known risk factors between the sexes. This review focuses on the potential role of oestrogen in explaining the male predominance in gastric cancer. Some data argue in favour of sex hormonal influence. Women with a longer fertility life and those on hormone replacement therapy seem to have a decreased risk of gastric cancer, and men who have been treated with oestrogen for prostate cancer have a decreased risk. Use of tamoxifen in women seems to increase their risk of gastric cancer. Animal studies indicate that oestrogen may offer protection against the development of this cancer as for example ovariectomised mice are at an increased risk, whilst administration of female sex hormones decreases the incidence of gastric cancer. Oestrogen may exert its effect by acting on oestrogen receptors (ERs). Both ERα, ERβ and the latest discovered ERβcx have been identified in gastric tissue. The biological means behind this is not yet clear but various mechanisms have been suggested. There are indications that oestrogen may lead to an increased expression of trefoil factor proteins, which protect mucous epithelia or inhibit the expression of c-erb-2 oncogene. [Copyright &y& Elsevier]

Surgery is the treatment of choice for localized esophageal and gastric cardia cancer. Our aim was to evaluate factors influencing postoperative short-term morbidity, 30-day mortality, and long-term prognosis. We identified 232 patients who had undergone surgical resection from a Swedish nationwide case control study of cancer of the esophagus and cardia between December 1, 1994 and December 31, 1997. Patients’ demographics, tumor characteristics, preoperative investigations, and treatments were reviewed. Patients were followed up through linkage to the Death Registry until December 2004. Survival curves were estimated by the Kaplan-Meier method. Cox proportional hazards regression models were used to derive hazard ratios (HRs) with 95% confidence intervals (CIs). The overall 5-year survival rate was 25%. Tumor stage was the most prominent prognostic factor for long-term survival. Low-volume hospital (HR = 1.3, 95% CI = 1.0–1.9), low-volume surgeon (HR = 1.4, 95% CI = 1.0-2.0), and postoperative need for respirator support (HR = 1.4, 95% CI = 1.0–1.9), were associated with a worse prognosis. Patients treated at low-volume hospitals or by low-volume surgeons needed respirator support more often or stayed longer at intensive care units after surgery. Patients with esophageal cancer have a modestly poorer prognosis when operated on at low-volume centers or by surgeons with less experience with esophageal cancer surgery. [ABSTRACT FROM AUTHOR]

Abstract: Background: Little is known about the possible influence of demographic and aetiologic risk factors on the survival amongst patients with oesophageal and cardia cancer. Methods: In a Swedish nationwide case–control study conducted in 1995–1997, 618 patients diagnosed with oesophageal or cardia cancer were interviewed regarding demographic and lifestyle factors, and followed up for survival through a 2004. Information about the treatment was collected through review of medical records, and 38 patients with missing records were excluded. Survival curves were estimated by Kaplan–Meier method. Cox proportional hazards regression models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for known or suspected prognostic factors. Results: Amongst the 580 included patients, 177 had oesophageal adenocarcinoma, 159 oesophageal squamous-cell carcinoma and 244 had cardia adenocarcinoma. Surgical resection was conducted in 224 patients (39%). The overall 5-year survival rate was 12%. Amongst patients with oesophageal adenocarcinoma, obese patients had a favourable prognosis compared to those of normal weight (HR=0.6, 95%CI 0.3–1.0). Amongst patients with oesophageal squamous-cell carcinoma, lean patients had a better prognosis (HR=0.6, 95%CI 0.4–1.0), whilst previous smokers (HR=2.1, 95%CI 1.0–4.4) and low educated (HR=1.9, 95%CI 1.1–3.4) had a worse prognosis. There were no statistically significant associations between sex, age, reflux symptoms, alcohol consumption or physical activity and prognosis in any of the three studied cancer subtypes. Conclusions: Body mass, tobacco smoking and education might influence the long-term survival of patients with oesophageal cancer. [Copyright &y& Elsevier]

Gastroesophageal reflux is the main risk factor for esophageal adenocarcinoma, but there is no strong support for a protective effect of antireflux surgery. We tested the hypothesis that esophageal adenocarcinoma that develops with long latency after antireflux surgery might be due to persistent postoperative reflux. A nationwide population-based case-control study in collaboration with 195 relevant Swedish hospital departments and tumor registries during the study period 1995–1997. Frequency-matched control persons were randomly selected from the population register. All study participants were personally interviewed regarding background data, exposures, symptoms, conditions, diseases, surgery, and medications. Differences between cases and controls in the occurrence of daily, long-standing antireflux medication 5 years or later after antireflux surgery were estimated using Fisher’s exact test. One hundred and eighty-nine out of 216 (88%) eligible cases of esophageal adenocarcinoma and 820 of 1,128 (73%) controls were prospectively enrolled. Seven (3.7%) patients and 8 controls had undergone antireflux surgery at least 5 years before the interview. All 7 case patients had Barrett’s mucosa. Four of the case patients had used postoperative antireflux medications continuously (mean duration 10.2 years), while none of the control persons reported such use ( P = 0.026). There was no difference in mean body mass index between patients with and without postoperative reflux ( P = 0.81). No differences between the patients and controls were found regarding age, sex, body mass index, or tobacco smoking status. Esophageal adenocarcinoma occurring late after antireflux surgery might at least partly be due to persistent postoperative reflux. Further research is required to establish the role of antireflux surgery in the etiology of this tumor. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to test the hypothesis that chewing gum is associated with risk of oesophageal and cardia adenocarcinoma. A Swedish nationwide, population-based, case-control study was conducted in 1995–1997. All patients were prospectively and uniformly documented and classified shortly after diagnosis. In all, 189 and 262 patients with oesophageal and cardia adenocarcinoma, respectively, and 820 population-based control subjects were interviewed. These patients together constituted 85% of eligible cases occurring in Sweden. Odds ratios (OR) with 95% confidence intervals (CI) were calculated by multivariable logistic regression with adjustment for plausible confounders. Regular users of chewing gum (P3 times/week for P6 months) were not at increased risk of oesophageal adenocarcinoma (OR 1.0, 95% CI 0.6–2.2), and no duration-response relation was observed (P =0.38). No association between regular gum chewing and cardia adenocarcinoma was found (OR 1.0, 95% CI 0.6–1.7), irrespective of duration of use (P =0.56). In conclusion, with regard to risk of oesophageal or cardia adenocarcinoma, gum chewing seems harmless. [Copyright &y& Elsevier]

The increased intake of carbonated soft drinks parallels the incidence of esophageal adenocarcinoma. To determine whether an association exists between carbonated drink intake and esophageal and cardia adenocarcinoma, we analyzed data from a Swedish nationwide, population-based, case-control study. During data collection in 1995–1997, 189 patients with esophageal adenocarcinoma (88% of all eligible), 262 patients with cardia adenocarcinoma (84%), and 820 control subjects (73%) were interviewed in person. All cancers were histologically classified. We calculated odds ratios with 95% confidence intervals using conditional logistic regression and multivariable analyses. Frequency of intake of carbonated soft drinks was not associated with risk of esophageal adenocarcinoma; high consumers (intake more than six times weekly) were at a statistically nonsignificantly decreased risk compared with never users (odds ratio = 0.89, 95% confidence interval = 0.49 to 1.64). Consumption of carbonated low-alcohol beer and combined intake of carbonated drinks were not associated with risk of esophageal adenocarcinoma. No association between intake of carbonated soft drinks or low-alcohol beer and risk of cardia adenocarcinoma was observed. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux (GER) is the strongest known risk factor for esophageal adenocarcinoma. For long-term sufferers with severe symptoms, the excess risk may exceed 40-fold. GER has also been shown to increase the risk of cancers of the gastric cardia more than fourfold. Several foods, including dietary fat, chocolate, mints, coffee, onions, citrus fruit, and tomatoes, have been associated with temporary symptoms of reflux, most likely through a relaxation of the lower esophageal sphincter (LES). Our aim was to determine whether these foods are associated with risk of adenocarcinoma of the esophagus or gastric cardia. We studied intakes of LES-relaxing foods and other dietary habits potentially associated with reflux in a nationwide population-based case-control study in Sweden, with 185 and 258 cases of esophageal adenocarcinoma and gastric cardia adenocarcinoma, respectively, and 815 controls. We found no association between LES-relaxing foods and symptoms of chronic reflux, although this might be due to avoidance of these foods among sufferers. In addition, we found no association between dietary factors known to cause LES relaxation and the risk of adenocarcinoma of the esophagus or gastric cardia. Our findings indicate that dietary factors associated with LES relaxation and transient GER (but perhaps not severe chronic reflux) are not associated with any important risk of esophageal malignancy. [ABSTRACT FROM AUTHOR]

Background: The incidence of esophageal adenocarcinoma is increasing rapidly. Gastroesophageal reflux is a strong risk factor for this disease. The increase in incidence of esophageal adenocarcinoma coincided with the introduction of medications that promote reflux by relaxing the lower esophageal sphincter (LES), such as nitroglycerin, anticholinergics, beta-adrenergic agonists, aminophyllines, and benzodiazepines.Objective: To test the possible association between use of LES-relaxing medications and risk for adenocarcinoma of the esophagus and gastric cardia.Design: A nationwide population-based case-control study with in-person interviews.Setting: Sweden, 1995 through 1997.Patients: 189 patients with newly diagnosed esophageal adenocarcinoma, 262 with adenocarcinoma of the gastric cardia, and 167 with esophageal squamous-cell carcinoma were compared with 820 population-based controls.Measurements: Estimated incidence rate ratios, calculated by using multivariate logistic regression from case-control data with adjustment for potential confounding.Results: Past use of LES-relaxing drugs was positively associated with risk for esophageal adenocarcinoma. Among daily, long-term users (>5 years) of LES-relaxing drugs, the estimated incidence rate ratio was 3.8 (95% CI, 2.2 to 6.4) compared with persons who had never used these drugs. Drugs of all classes contributed to the increased risk, but the association was particularly strong for anticholinergics. Short-term use of other types of LES-relaxing drugs did not seem to be strongly associated with risk. The association almost disappeared after adjustment for reflux symptoms, indicating that promotion of reflux is the link between use of LES-relaxing drugs and esophageal adenocarcinoma. If 15,490 men in any age group take LES-relaxing drugs daily for 5 years, 1 additional case of adenocarcinoma would be expected (number needed to treat for harm); in men older than 60 years of age, the number needed to treat for harm is 5,570. Assuming a causal relation, about 10% of the esophageal adenocarcinomas occurring in the population may be attributable to intake of LES-relaxing drugs. Cardia adenocarcinoma and esophageal squamous-cell carcinoma were not associated with use of LES-relaxing drugs.Conclusions: The widespread use of LES-relaxing drugs may have contributed to the increasing incidence of esophageal adenocarcinoma. [ABSTRACT FROM AUTHOR]

The article presents the discussion on follow-up of many participants of old age and mortality from other causes than esophageal squamous cell carcinoma using a competing risk regression.

Oesophago-gastric cancers have had sharply different and changing incidence patterns depending on subsite and histology, but incidence data for the last few years are missing. We aimed to provide updated incidence trends of oesophago-gastric tumours by subsite and histology in Sweden. The Swedish Cancer Registry provided data for 74,303 patients with oesophago-gastric cancer aged ≥50 years in 1970–2020. The focus was on the last available 6-year period, i.e., from 2015 until 2020 inclusive. We calculated yearly age-standardized and sex-specific incidence rates per 100,000 person-years, with the age distribution (in 5-year age groups) of the Swedish population in year 2000 as reference. For oesophageal squamous cell carcinoma, the incidence continued to decrease between 2015 and 2020 (from 6.46 to 5.53/100,000 person-years in men, and from 4.26 to 3.78/100,000 person-years in women). For oesophageal adenocarcinoma, the earlier increasing incidence rates rather slightly decreased in men between 2015 and 2020 (from 12.39 to 11.70/100,000 person-years) and increased marginally in women (from 2.49 to 2.85/100,000 person-years). The incidence rates of cardia adenocarcinoma were stable between 2015 and 2020 (from 9.83 to 10.13/100,000 person-years in men, and from 2.21 to 2.41/100,000 person-years in women). For gastric non-cardia adenocarcinoma, the incidence rates continued to decrease between 2015 and 2020 (from 14.67 to 13.29/100,000 person-years in men, and from 9.37 to 8.14/100,000 person-years in women). There were no major age-group differences in recent incidence trends. The 6-year period from 2015 to 2020 inclusive has witnessed stabilising incidence rates of oesophageal and cardia adenocarcinoma in Sweden, whereas the incidence rates of oesophageal squamous cell carcinoma and non-cardia gastric adenocarcinoma have continued to decrease. [ABSTRACT FROM AUTHOR]

Background: Late effects of chemotherapy could affect mortality amongst cancer survivors. This study aimed to clarify if neoadjuvant chemotherapy for gastric adenocarcinoma influences the long-term survival in individuals cured of this tumour.This was a nationwide and population-based cohort study that included all individuals who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 and survived for ≥ 5 years after surgery. The cohort was followed up until death or end of study period (31 December 2020). Multivariable Cox proportional hazards regression was used to provide hazard ratios (HR) with 95% confidence intervals (CI). The HR were adjusted for age, sex, comorbidity, education, calendar year, tumour sub-location, in-hospital complications, and splenectomy. Data came from medical records and nationwide registers.Amongst 613 gastric adenocarcinoma survivors, neoadjuvant chemotherapy (used in 269 patients; 43.9%) was associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46–0.96). However, the association attenuated and became statistically non-significant after adjustment for all confounders (HR 0.83, 95% CI 0.56–1.23) and after adjustments solely for age and comorbidity (HR 0.82, 95% CI 0.56–1.20). Stratified analyses did not reveal any statistically significant associations between neoadjuvant chemotherapy and long-term mortality in categories of age, sex, comorbidity, calendar year and tumour sub-location.Neoadjuvant chemotherapy did not decrease the long-term survival amongst gastric adenocarcinoma survivors. Patients who received neoadjuvant chemotherapy were a selected group characterised by younger age and fewer severe comorbidities and therefore with better chances of long-term survival.Methods: Late effects of chemotherapy could affect mortality amongst cancer survivors. This study aimed to clarify if neoadjuvant chemotherapy for gastric adenocarcinoma influences the long-term survival in individuals cured of this tumour.This was a nationwide and population-based cohort study that included all individuals who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 and survived for ≥ 5 years after surgery. The cohort was followed up until death or end of study period (31 December 2020). Multivariable Cox proportional hazards regression was used to provide hazard ratios (HR) with 95% confidence intervals (CI). The HR were adjusted for age, sex, comorbidity, education, calendar year, tumour sub-location, in-hospital complications, and splenectomy. Data came from medical records and nationwide registers.Amongst 613 gastric adenocarcinoma survivors, neoadjuvant chemotherapy (used in 269 patients; 43.9%) was associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46–0.96). However, the association attenuated and became statistically non-significant after adjustment for all confounders (HR 0.83, 95% CI 0.56–1.23) and after adjustments solely for age and comorbidity (HR 0.82, 95% CI 0.56–1.20). Stratified analyses did not reveal any statistically significant associations between neoadjuvant chemotherapy and long-term mortality in categories of age, sex, comorbidity, calendar year and tumour sub-location.Neoadjuvant chemotherapy did not decrease the long-term survival amongst gastric adenocarcinoma survivors. Patients who received neoadjuvant chemotherapy were a selected group characterised by younger age and fewer severe comorbidities and therefore with better chances of long-term survival.Results: Late effects of chemotherapy could affect mortality amongst cancer survivors. This study aimed to clarify if neoadjuvant chemotherapy for gastric adenocarcinoma influences the long-term survival in individuals cured of this tumour.This was a nationwide and population-based cohort study that included all individuals who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 and survived for ≥ 5 years after surgery. The cohort was followed up until death or end of study period (31 December 2020). Multivariable Cox proportional hazards regression was used to provide hazard ratios (HR) with 95% confidence intervals (CI). The HR were adjusted for age, sex, comorbidity, education, calendar year, tumour sub-location, in-hospital complications, and splenectomy. Data came from medical records and nationwide registers.Amongst 613 gastric adenocarcinoma survivors, neoadjuvant chemotherapy (used in 269 patients; 43.9%) was associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46–0.96). However, the association attenuated and became statistically non-significant after adjustment for all confounders (HR 0.83, 95% CI 0.56–1.23) and after adjustments solely for age and comorbidity (HR 0.82, 95% CI 0.56–1.20). Stratified analyses did not reveal any statistically significant associations between neoadjuvant chemotherapy and long-term mortality in categories of age, sex, comorbidity, calendar year and tumour sub-location.Neoadjuvant chemotherapy did not decrease the long-term survival amongst gastric adenocarcinoma survivors. Patients who received neoadjuvant chemotherapy were a selected group characterised by younger age and fewer severe comorbidities and therefore with better chances of long-term survival.Conclusion: Late effects of chemotherapy could affect mortality amongst cancer survivors. This study aimed to clarify if neoadjuvant chemotherapy for gastric adenocarcinoma influences the long-term survival in individuals cured of this tumour.This was a nationwide and population-based cohort study that included all individuals who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 and survived for ≥ 5 years after surgery. The cohort was followed up until death or end of study period (31 December 2020). Multivariable Cox proportional hazards regression was used to provide hazard ratios (HR) with 95% confidence intervals (CI). The HR were adjusted for age, sex, comorbidity, education, calendar year, tumour sub-location, in-hospital complications, and splenectomy. Data came from medical records and nationwide registers.Amongst 613 gastric adenocarcinoma survivors, neoadjuvant chemotherapy (used in 269 patients; 43.9%) was associated with a decreased crude mortality rate (HR 0.66, 95% CI 0.46–0.96). However, the association attenuated and became statistically non-significant after adjustment for all confounders (HR 0.83, 95% CI 0.56–1.23) and after adjustments solely for age and comorbidity (HR 0.82, 95% CI 0.56–1.20). Stratified analyses did not reveal any statistically significant associations between neoadjuvant chemotherapy and long-term mortality in categories of age, sex, comorbidity, calendar year and tumour sub-location.Neoadjuvant chemotherapy did not decrease the long-term survival amongst gastric adenocarcinoma survivors. Patients who received neoadjuvant chemotherapy were a selected group characterised by younger age and fewer severe comorbidities and therefore with better chances of long-term survival. [ABSTRACT FROM AUTHOR]

Background: It is unknown if gastric adenocarcinoma survivors have longer, shorter, or similar survival compared to the background population. This knowledge could contribute to evidence-based monitoring strategies, healthcare recommendations, and information for patients and families.This population-based cohort study included all patients who underwent gastrectomy for gastric adenocarcinoma between 2006–2015 in Sweden and survived ≥ 5 years after surgery. They were followed up until death, postoperative year 10, or end of study period (31 December, 2020). Division of the observed by the expected survival yielded relative survival rates with 95% confidence intervals (CIs) using the life table method. The expected survival was derived from the entire Swedish population of the corresponding age, sex, and calendar year. Data came from medical records and nationwide registers.The survival among all 767 gastric adenocarcinoma survivors was shorter than the expected. The reduction in relative survival increased for each follow-up year, from 97.3% (95% CI 95.4–99.1%) year 6 to 86.6% (95% CI 82.3–90.9%) year 10. The decline in relative survival was more pronounced among patients who had gastrectomy in earlier calendar years (82.9% [95% CI 77.4–88.4%] year 10 for years 2011–2015), shorter education (85.2% [95% CI 77.4–93.0%] year 10 for education ≤ 9 years), more comorbidities (78.0% [95% CI 63.9–92.0%] year 10 for Charlson comorbidity score ≥ 2), and no neoadjuvant therapy (83.2% [95% CI 77.4–89.0%] year 10).Gastric adenocarcinoma survivors seem to have poorer survival than the corresponding background population, particularly in certain subgroups.Methods: It is unknown if gastric adenocarcinoma survivors have longer, shorter, or similar survival compared to the background population. This knowledge could contribute to evidence-based monitoring strategies, healthcare recommendations, and information for patients and families.This population-based cohort study included all patients who underwent gastrectomy for gastric adenocarcinoma between 2006–2015 in Sweden and survived ≥ 5 years after surgery. They were followed up until death, postoperative year 10, or end of study period (31 December, 2020). Division of the observed by the expected survival yielded relative survival rates with 95% confidence intervals (CIs) using the life table method. The expected survival was derived from the entire Swedish population of the corresponding age, sex, and calendar year. Data came from medical records and nationwide registers.The survival among all 767 gastric adenocarcinoma survivors was shorter than the expected. The reduction in relative survival increased for each follow-up year, from 97.3% (95% CI 95.4–99.1%) year 6 to 86.6% (95% CI 82.3–90.9%) year 10. The decline in relative survival was more pronounced among patients who had gastrectomy in earlier calendar years (82.9% [95% CI 77.4–88.4%] year 10 for years 2011–2015), shorter education (85.2% [95% CI 77.4–93.0%] year 10 for education ≤ 9 years), more comorbidities (78.0% [95% CI 63.9–92.0%] year 10 for Charlson comorbidity score ≥ 2), and no neoadjuvant therapy (83.2% [95% CI 77.4–89.0%] year 10).Gastric adenocarcinoma survivors seem to have poorer survival than the corresponding background population, particularly in certain subgroups.Results: It is unknown if gastric adenocarcinoma survivors have longer, shorter, or similar survival compared to the background population. This knowledge could contribute to evidence-based monitoring strategies, healthcare recommendations, and information for patients and families.This population-based cohort study included all patients who underwent gastrectomy for gastric adenocarcinoma between 2006–2015 in Sweden and survived ≥ 5 years after surgery. They were followed up until death, postoperative year 10, or end of study period (31 December, 2020). Division of the observed by the expected survival yielded relative survival rates with 95% confidence intervals (CIs) using the life table method. The expected survival was derived from the entire Swedish population of the corresponding age, sex, and calendar year. Data came from medical records and nationwide registers.The survival among all 767 gastric adenocarcinoma survivors was shorter than the expected. The reduction in relative survival increased for each follow-up year, from 97.3% (95% CI 95.4–99.1%) year 6 to 86.6% (95% CI 82.3–90.9%) year 10. The decline in relative survival was more pronounced among patients who had gastrectomy in earlier calendar years (82.9% [95% CI 77.4–88.4%] year 10 for years 2011–2015), shorter education (85.2% [95% CI 77.4–93.0%] year 10 for education ≤ 9 years), more comorbidities (78.0% [95% CI 63.9–92.0%] year 10 for Charlson comorbidity score ≥ 2), and no neoadjuvant therapy (83.2% [95% CI 77.4–89.0%] year 10).Gastric adenocarcinoma survivors seem to have poorer survival than the corresponding background population, particularly in certain subgroups.Conclusion: It is unknown if gastric adenocarcinoma survivors have longer, shorter, or similar survival compared to the background population. This knowledge could contribute to evidence-based monitoring strategies, healthcare recommendations, and information for patients and families.This population-based cohort study included all patients who underwent gastrectomy for gastric adenocarcinoma between 2006–2015 in Sweden and survived ≥ 5 years after surgery. They were followed up until death, postoperative year 10, or end of study period (31 December, 2020). Division of the observed by the expected survival yielded relative survival rates with 95% confidence intervals (CIs) using the life table method. The expected survival was derived from the entire Swedish population of the corresponding age, sex, and calendar year. Data came from medical records and nationwide registers.The survival among all 767 gastric adenocarcinoma survivors was shorter than the expected. The reduction in relative survival increased for each follow-up year, from 97.3% (95% CI 95.4–99.1%) year 6 to 86.6% (95% CI 82.3–90.9%) year 10. The decline in relative survival was more pronounced among patients who had gastrectomy in earlier calendar years (82.9% [95% CI 77.4–88.4%] year 10 for years 2011–2015), shorter education (85.2% [95% CI 77.4–93.0%] year 10 for education ≤ 9 years), more comorbidities (78.0% [95% CI 63.9–92.0%] year 10 for Charlson comorbidity score ≥ 2), and no neoadjuvant therapy (83.2% [95% CI 77.4–89.0%] year 10).Gastric adenocarcinoma survivors seem to have poorer survival than the corresponding background population, particularly in certain subgroups. [ABSTRACT FROM AUTHOR]

Background: Infection with human papillomavirus (HPV) type 16 has been implicated as a risk factor for esophageal squamous cell carcinoma in three seroepidemiologic studies. We conducted a larger, population-based study to verify this association and to investigate possible confounding factors.Methods: We performed a nationwide case-control study in Sweden of HPV16 or HPV18 infection and risk of esophageal squamous cell carcinoma or esophageal/gastroesophageal adenocarcinoma. Tumors were strictly classified by their location and histologic type. Case subjects with incident cancers and population-based control subjects donated blood samples and were interviewed in person about potential confounding factors. An enzyme-linked immunosorbent assay was used to detect HPV seropositivity. Multivariate analyses were conducted to study relationships between HPV seropositivity, level of education, smoking (all tobacco) status, alcohol consumption, and cancer risk.Results: We compared 121 case subjects with esophageal squamous cell carcinoma and 173 case subjects with adenocarcinoma of the esophagus or gastroesophageal junction with 302 population-based control subjects. The age- and sex-adjusted odds ratios (ORs) for squamous cell carcinoma were 1.0 (95% confidence interval [CI] = 0.5-2.0) for persons seropositive for HPV16 and 0.5 (95% CI = 0.2-1.1) for persons seropositive for HPV18 in comparison with seronegative individuals. The corresponding ORs for adenocarcinoma were 1.2 (95% CI = 0.7-2.2) and 0.2 (95% CI = 0.1-0.7), respectively. Adjustments for smoking status, alcohol consumption, and level of education did not alter the results.Conclusions: We found no evidence of a positive association between HPV16 or HPV18 infection and either form of esophageal cancer. Our results do not support conclusions from previous studies. [ABSTRACT FROM AUTHOR]

Examines the relationship between body mass index (BMI) and development of adenocarcinoma of the esophagus and gastric cardia. Dose-dependent relation between BMI and esophageal adenocarcinoma; Odds ratio in patients with either esophageal or gastric cardia adenocarcinoma; No significant relationship between esophageal squamous cell carcinoma and BMI.

Background: To investigate if anti-androgenic medications 5α-reductase inhibitors (5-ARIs) decrease the risk of developing oesophageal and gastric tumours, analysed by histological type and anatomical sub-site. Methods: A Swedish population-based cohort study between 2005 and 2018 where men using 5-ARIs were considered exposed. For each exposed participant, ten male age-matched non-users of 5-ARIs (non-exposed) were included. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, smoking, non-steroidal anti-inflammatory drugs/aspirin use, and statins use. Further adjustments were made depending on the tumour analysed. Results: The cohort included 191,156 users of 5-ARIs and 1,911,560 non-users. Overall, the use of 5-ARIs was not associated with any statistically significantly reduced risk of oesophageal or cardia adenocarcinoma (adjusted HR 0.92, 95% CI 0.82–1.02) or gastric non-cardia adenocarcinoma (adjusted HR 0.90, 95% CI 0.80–1.02). However, the use of 5-ARIs indicated a decreased risk of oesophageal or cardia adenocarcinoma among obese or diabetic participants (adjusted HR 0.55, 95% CI 0.39–0.80) and a reduced risk of oesophageal squamous cell carcinoma (adjusted HR 0.49, 95% CI 0.37–0.65). Conclusion: Users of 5-ARIs may have a decreased risk of developing oesophageal or cardia adenocarcinoma among those obese or diabetic, and a decreased risk of oesophageal squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Background: To investigate if anti-androgenic medications 5α-reductase inhibitors (5-ARIs) decrease the risk of developing oesophageal and gastric tumours, analysed by histological type and anatomical sub-site.Methods: A Swedish population-based cohort study between 2005 and 2018 where men using 5-ARIs were considered exposed. For each exposed participant, ten male age-matched non-users of 5-ARIs (non-exposed) were included. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, smoking, non-steroidal anti-inflammatory drugs/aspirin use, and statins use. Further adjustments were made depending on the tumour analysed.Results: The cohort included 191,156 users of 5-ARIs and 1,911,560 non-users. Overall, the use of 5-ARIs was not associated with any statistically significantly reduced risk of oesophageal or cardia adenocarcinoma (adjusted HR 0.92, 95% CI 0.82-1.02) or gastric non-cardia adenocarcinoma (adjusted HR 0.90, 95% CI 0.80-1.02). However, the use of 5-ARIs indicated a decreased risk of oesophageal or cardia adenocarcinoma among obese or diabetic participants (adjusted HR 0.55, 95% CI 0.39-0.80) and a reduced risk of oesophageal squamous cell carcinoma (adjusted HR 0.49, 95% CI 0.37-0.65).Conclusion: Users of 5-ARIs may have a decreased risk of developing oesophageal or cardia adenocarcinoma among those obese or diabetic, and a decreased risk of oesophageal squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Background Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores. Results Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300 mL did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59). Conclusion Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies. [ABSTRACT FROM AUTHOR]

Summary: At first the association between body mass, reflux, and oesophageal adenocarcinoma might seem easily interpreted, but a more thorough assessment of the published work shows that several factors are missing. Reflux and obesity are established risk factors for oesophageal adenocarcinoma, particularly when they occur in combination. However, the interplay between these and other factors with regard to oesophageal adenocarcinoma is uncertain. Moreover, the contribution of these risk factors in explaining the increasing incidence of oesophageal adenocarcinoma is unclear, because the trends in prevalence of reflux and obesity do not match those of incidence of oesophageal adenocarcinoma. Moreover, none of these factors contribute strongly to the striking predominance of oesophageal adenocarcinoma in men. Thus, several factors that can explain the development of oesophageal adenocarcinoma need to be addressed. [Copyright &y& Elsevier]

Gastro-oesophageal reflux disease (GORD) is recognized by symptoms of heartburn and acid regurgitation. These gastro-oesophageal reflux symptoms (GORS) are common in adults, but data from adolescents are sparse. This study aimed to assess the prevalence and risk factors of GORS among adolescents in a large and unselected population. This study was based on the Trøndelag Health Study (HUNT), a longitudinal series of population-based health surveys conducted in Nord-Trøndelag County, Norway. This study included data from Young-HUNT4 performed in 2017–2019, where all inhabitants aged 13–19 years were invited and 8066 (76.0%) participated. The presence of GORS (any or frequent) during the past 12 months and tobacco smoking status were reported through self-administrated questionnaires, whereas body mass index (BMI) was objectively measured. Among 7620 participating adolescents reporting on the presence of GORS, the prevalence of any GORS and frequent GORS was 33.2% (95% confidence interval [CI] 32.2 − 34.3%) and 3.6% (95% CI 3.2 − 4.0%), respectively. The risk of frequent GORS was lower among boys compared to girls (OR 0.61; 95% CI 0.46 − 0.79), higher in current smokers compared to never smokers (OR 1.80; 95% CI 1.10 − 2.93) and higher among obese compared to underweight/normal weight adolescents (OR 2.50; 95% CI 1.70 − 3.66). A considerable proportion of adolescents had GORS in this population-based study, particularly girls, tobacco smokers, and individuals with obesity, but frequent GORS was relatively uncommon. Measures to avoid tobacco smoking and obesity in adolescents may prevent GORS. [ABSTRACT FROM AUTHOR]

Background: Studies have suggested that medication with statins improves survival in patients with gastric cancer, but methodological issues have limited the interpretability and prohibited conclusive results. We aimed to provide valid evidence as to whether statin use improves survival of gastric adenocarcinoma. Methods: This nationwide and population-based cohort study included virtually all patients who underwent curatively intended surgery (gastrectomy) for gastric adenocarcinoma in Sweden between 2006 and 2015 with follow-up throughout 2019 for disease-specific mortality and 2020 for all-cause mortality. Data came from medical records and national healthcare registries. The exposure was statin use during the year prior to gastrectomy which was compared to no such use during the same period. The outcomes were 5-year disease-specific mortality (main) and 5-year all-cause mortality (secondary). Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, education, calendar year, comorbidity, low-dose aspirin use, tumour sublocation, pathological tumour stage, neoadjuvant chemotherapy, annual surgeon volume, and surgical radicality. Results: Among 1515 participating patients, the mean age was 69 years and 58.4% were men. Statin use, identified in 399 (26.3%) patients, was not associated with any statistically significantly decreased 5-year disease-specific mortality (HR 0.99, 95% CI 0.82–1.21) or 5-year all-cause mortality (HR 0.94, 95% CI 0.79–1.12). No risk reductions were found across subgroups of age, sex, aspirin user status, or tumour stage, or in patients with long-term preoperative of postoperative use of statins, all with point estimates close to 1. Conclusions: Perioperative use of statins does not seem to improve the 5-year survival in patients who undergo gastrectomy with curative intent for gastric adenocarcinoma in Sweden. [ABSTRACT FROM AUTHOR]

Background: Oesophageal adenocarcinoma is characterised by a strong male predominance. We aimed to test the hypothesis that menopausal hormonal therapy decreases the risk of oesophageal adenocarcinoma.Methods: This population-based cohort study included all women who used systemic menopausal hormonal therapy (exposed) in Sweden between 2005 and 2018. For each exposed participant, five randomly selected female age-matched non-users of menopausal hormonal therapy (unexposed) were included. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, smoking-related diagnoses, Helicobacter pylori eradication, use of non-steroidal anti-inflammatory drugs/aspirin, use of statins and hysterectomy.Results: The study included 296,964 users of menopausal hormonal therapy and 1,484,820 non-users. Ever-users of menopausal hormonal therapy had an overall decreased risk of oesophageal adenocarcinoma (HR 0.78, 95% CI 0.63-0.97), which remained unchanged after further adjustment for gastro-oesophageal reflux disease (HR 0.78, 95% CI 0.63-0.97) and obesity/diabetes (HR 0.79, 95% CI 0.63-0.98). Decreased HRs were indicated both in users of oestrogen only (HR 0.82, 95% CI 0.60-1.12) and oestrogen combined with progestogen (HR 0.75, 95% CI 0.56-1.00). The risk reduction was more pronounced in users younger than 60 years (HR 0.57, 95% CI 0.38-0.86).Conclusions: Menopausal hormone therapy in women may decrease the risk of oesophageal adenocarcinoma. [ABSTRACT FROM AUTHOR]

Importance: Gastroesophageal reflux disease (GERD) is defined by recurrent and troublesome heartburn and regurgitation or GERD-specific complications and affects approximately 20% of the adult population in high-income countries.Observations: GERD can influence patients' health-related quality of life and is associated with an increased risk of esophagitis, esophageal strictures, Barrett esophagus, and esophageal adenocarcinoma. Obesity, tobacco smoking, and genetic predisposition increase the risk of developing GERD. Typical GERD symptoms are often sufficient to determine the diagnosis, but less common symptoms and signs, such as dysphagia and chronic cough, may occur. Patients with typical GERD symptoms can be medicated empirically with a proton pump inhibitor (PPI). Among patients who do not respond to such treatment or if the diagnosis is unclear, endoscopy, esophageal manometry, and esophageal pH monitoring are recommended. Patients with GERD symptoms combined with warning symptoms of malignancy (eg, dysphagia, weight loss, bleeding) and those with other main risk factors for esophageal adenocarcinoma, such as older age, male sex, and obesity, should undergo endoscopy. Lifestyle changes, medication, and surgery are the main treatment options for GERD. Weight loss and smoking cessation are often useful. Medication with a PPI is the most common treatment, and after initial full-dose therapy, which usually is omeprazole 20 mg once daily, the aim is to use the lowest effective dose. Observational studies have suggested several adverse effects after long-term PPI, but these findings need to be confirmed before influencing clinical decision making. Surgery with laparoscopic fundoplication is an invasive treatment alternative in select patients after thorough and objective assessments, particularly if they are young and healthy. Endoscopic and less invasive surgical techniques are emerging, which may reduce the use of long-term PPI and fundoplication, but the long-term safety and efficacy remain to be scientifically established.Conclusions and Relevance: The clinical management of GERD influences the lives of many individuals and is responsible for substantial consumption of health care and societal resources. Treatments include lifestyle modification, PPI medication, and laparoscopic fundoplication. New endoscopic and less invasive surgical procedures are evolving. PPI use remains the dominant treatment, but long-term therapy requires follow-up and reevaluation for potential adverse effects. [ABSTRACT FROM AUTHOR]