OBJECTIVE:The mechanism behind the epidemiologically evident inverse relation between Helicobacter pylori seropositivity and risk of oesophageal adenocarcinoma (OAC) remains obscure. Severe corpus gastritis is unlikely to be in the causal pathway. With the hypothesis of a uniformly low risk, the associations of OAC with duodenal ulcer and gastric ulcer were explored, both linked to H pylori infection but with different patterns of bacterial colonisation and intragastric acidity. Possible associations of oesophageal squamous cell carcinoma (OSCC) with these ulcer types were also addressed. DESIGN AND PATIENTS:Retrospective cohorts of 61,548 and 81,379 unoperated patients with duodenal ulcer and gastric ulcer, respectively, recorded in the Swedish Inpatient Register since 1965, were followed from the first hospitalisation until the date of any cancer, death, emigration, definitive surgery, or 31 December 2003. Standardised incidence ratios (SIRs), with 95% CIs, expressed relative risk of oesophageal cancer, compared with the Swedish population matched for age, sex and calendar period. RESULTS:Contrary to expectation, patients with duodenal ulcer had a significant 70% excess risk of OAC (SIR 1.7, 95% CI 1.1 to 2.5). Gastric ulcer was unrelated to OAC (SIR 1.1, 95% CI 0.6 to 1.7). Although duodenal ulcer was non-significantly associated with a small excess of OSCC (SIR 1.3, 95% CI 0.96 to 1.8), gastric ulcer was linked to 80% increased risk (SIR 1.8, 95% CI 1.4 to 2.3). CONCLUSION:The inverse association between H pylori and OAC does not pertain to all infections. The pattern of gastric colonisation and/or impact on acidity may be important. With the reservation for the possibility of confounding, this study also provides some support for the importance of intragastric environment in the aetiology of OSCC.

译文

目的:幽门螺杆菌血清阳性与食管腺癌(OAC)风险之间的流行病学证据呈负相关。严重的胃炎胃炎不太可能在因果关系中。假设风险均一,探讨了OAC与十二指肠溃疡和胃溃疡的相关性,两者均与幽门螺杆菌感染有关,但细菌定植和胃内酸度不同。食管鳞状细胞癌(OSCC)与这些溃疡类型的可能关联也得到了解决。
设计和患者:自1965年以来在瑞典住院患者登记表中记录的分别有61,548和81,379例未手术的十二指肠溃疡和胃溃疡患者的回顾性队列,从首次住院治疗直至癌症,死亡,移民,定型手术,或2003年12月31日。与年龄,性别和日历时期相匹配的瑞典人口相比,具有95%CI的标准发生率(SIR)表示食道癌的相对风险。
结果:与预期相反,十二指肠溃疡患者发生OAC的风险显着增加70%(SIR 1.7,95%CI 1.1至2.5)。胃溃疡与OAC无关(SIR 1.1,95%CI 0.6至1.7)。尽管十二指肠溃疡与OSCC的少量过量无显着相关性(SIR 1.3,95%CI 0.96至1.8),但胃溃疡与80%的风险增加相关(SIR 1.8,95%CI 1.4至2.3)。
结论:幽门螺杆菌与OAC之间的负相关并不适用于所有感染。胃定植的模式和/或对酸度的影响可能很重要。由于保留了混淆的可能性,本研究还为胃内环境在OSCC病因中的重要性提供了一些支持。

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