Abstract：
Antireflux treatment is recommended to reduce esophageal adenocarcinoma in patients with Barrett\'s esophagus. Antireflux surgery (fundoplication) counteracts gastroesophageal reflux of all types of carcinogenic gastric content and reduces esophageal acid exposure to a greater extent than antireflux medication (eg, proton pump inhibitors). We examined the hypothesis that antireflux surgery prevents esophageal adenocarcinoma to a larger degree than antireflux medication in patients with Barrett\'s esophagus.
This multinational and population-based cohort study included all patients with a diagnosis of Barrett\'s esophagus in any of the national patient registries in Denmark (2012-2020), Finland (1987-1996 and 2010-2020), Norway (2008-2020), or Sweden (2006-2020). Patients who underwent antireflux surgery were compared with nonoperated patients using antireflux medication. The risk of esophageal adenocarcinoma was calculated using multivariable Cox regression, providing hazard ratios (HRs) and 95% CIs adjusted for age, sex, country, calendar year, and comorbidity.
The cohort consisted of 33,939 patients with Barrett\'s esophagus. Of these, 542 (1.6%) had undergone antireflux surgery. During up to 32 years of follow-up, the overall HR was not decreased in patients having undergone antireflux surgery compared with nonoperated patients using antireflux medication, but rather increased (adjusted HR, 1.9; 95% CI, 1.1-3.5). In addition, HRs did not decrease with longer follow-up, but instead increased for each follow-up category, from 1.8 (95% CI, 0.6-5.0) within 1-4 years of follow-up to 4.4 (95% CI, 1.4-13.5) after 10-32 years of follow-up.
Patients with Barrett\'s esophagus who undergo antireflux surgery do not seem to have a lower risk of esophageal adenocarcinoma than those using antireflux medication.
This multinational and population-based cohort study included all patients with a diagnosis of Barrett\'s esophagus in any of the national patient registries in Denmark (2012-2020), Finland (1987-1996 and 2010-2020), Norway (2008-2020), or Sweden (2006-2020). Patients who underwent antireflux surgery were compared with nonoperated patients using antireflux medication. The risk of esophageal adenocarcinoma was calculated using multivariable Cox regression, providing hazard ratios (HRs) and 95% CIs adjusted for age, sex, country, calendar year, and comorbidity.
The cohort consisted of 33,939 patients with Barrett\'s esophagus. Of these, 542 (1.6%) had undergone antireflux surgery. During up to 32 years of follow-up, the overall HR was not decreased in patients having undergone antireflux surgery compared with nonoperated patients using antireflux medication, but rather increased (adjusted HR, 1.9; 95% CI, 1.1-3.5). In addition, HRs did not decrease with longer follow-up, but instead increased for each follow-up category, from 1.8 (95% CI, 0.6-5.0) within 1-4 years of follow-up to 4.4 (95% CI, 1.4-13.5) after 10-32 years of follow-up.
Patients with Barrett\'s esophagus who undergo antireflux surgery do not seem to have a lower risk of esophageal adenocarcinoma than those using antireflux medication.
摘要：
目的：推荐抗反流治疗以减少Barrett食管患者的食管腺癌。抗反流手术（胃底折叠术）可抵消所有类型的致癌胃内容物的胃食管反流，与抗反流药物（质子泵抑制剂）相比，食管酸暴露更大程度地减少。我们研究了以下假设：在Barrett食管患者中，抗反流手术比抗反流药物更大程度地预防食管腺癌。
方法：这项跨国和基于人群的队列研究纳入了丹麦任何国家患者登记（2012-2020）中所有诊断为Barrett食管的患者，芬兰（1987-1996年和2010-2020年），挪威（2008-2020年），或瑞典（2006-2020年）。将接受抗反流手术的患者与使用抗反流药物的非手术患者进行比较。使用多变量Cox回归计算食管腺癌的风险，提供根据年龄调整的95%置信区间(CI)的风险比(HR)，性别,国家,日历年,和合并症。
结果：该队列包括33,939例Barrett食管患者。其中,542（1.6％）接受了抗反流手术。在长达32年的随访中，与使用抗反流药物的非手术患者相比,接受抗反流手术的患者的总HR没有降低,而是升高(校正HR1.9,95%CI1.1~3.5).此外,HR没有随着随访时间的延长而降低，但每个后续类别都增加了，从随访1-4年内的1.8（95％CI0.6-5.0）到随访10-32年后的4.4（95％CI1.4-13.5）。
结论：接受抗反流手术的Barrett食管患者似乎没有比使用抗反流药物的患者更低的食管腺癌风险。
方法：这项跨国和基于人群的队列研究纳入了丹麦任何国家患者登记（2012-2020）中所有诊断为Barrett食管的患者，芬兰（1987-1996年和2010-2020年），挪威（2008-2020年），或瑞典（2006-2020年）。将接受抗反流手术的患者与使用抗反流药物的非手术患者进行比较。使用多变量Cox回归计算食管腺癌的风险，提供根据年龄调整的95%置信区间(CI)的风险比(HR)，性别,国家,日历年,和合并症。
结果：该队列包括33,939例Barrett食管患者。其中,542（1.6％）接受了抗反流手术。在长达32年的随访中，与使用抗反流药物的非手术患者相比,接受抗反流手术的患者的总HR没有降低,而是升高(校正HR1.9,95%CI1.1~3.5).此外,HR没有随着随访时间的延长而降低，但每个后续类别都增加了，从随访1-4年内的1.8（95％CI0.6-5.0）到随访10-32年后的4.4（95％CI1.4-13.5）。
结论：接受抗反流手术的Barrett食管患者似乎没有比使用抗反流药物的患者更低的食管腺癌风险。
