Antacid Drug Use and Risk of Esophageal and Gastric Adenocarcinomas in Los Angeles County
Antacid Drug Use and Risk of Esophageal and Gastric Adenocarcinomas in Los Angeles County
复制标题
DOI：
10.1158/1055-9965.epi-08-0764
复制
发表时间：
2009-02-01
影响因子：
3.8
通讯作者：
Bernstein, Leslie
中科院分区：
文献类型：
--
作者：
Duan, Lei;Wu, Anna H.;Bernstein, Leslie
目的：人们关注抗酸药物增加食管癌和胃腺癌的风险。方法：这项基于人群的病例对照研究招募了1992年至1997年间诊断为食管腺癌（n = 220）、胃心腺癌（n = 277）或远端胃腺癌（n = 441）的患者，以及洛杉矶县1356名对照参与者。进行了无条件多变量logistic回归分析，以评估抗酸药物使用与这些癌症之间的关系。结果：在服用非处方酸中和剂3年的参与者中，与从未使用过的参与者相比，食管癌的优势比为6.32（95%可信区间为3.14-12.69，p趋势< 0.01）。根据医生诊断的上消化道（UGI）疾病病史分层分析显示，与有UGI疾病的患者相比，无UGI疾病的患者使用非处方抗酸药增加了食管腺癌的风险（趋势的同质性P = 0.07）。经常使用非处方酸中和剂与贲门腺癌或远端胃腺癌的风险无关。定期使用处方抑酸药物与患上述任何一种癌症的风险无关。结论：我们发现，在没有医生诊断的UGI疾病的参与者中，长期服用非处方酸中和药物的患者患食管腺癌的风险高于患有这些疾病的参与者；这可能是对未确诊的前驱疾病的自我药物治疗，也可能是在症状最强烈时无限制服用非处方酸中和药物，可能使碱性胆汁反流到食管下部，从而增加食管腺癌的风险。（癌症流行病学杂志，2009;18(2):526-33）
Objectives: Concern has been expressed that antacid drugs increase the risk of esophageal and gastric adenocarcinomas.Methods: This population-based case-control study recruited patients with incident esophageal adenocarcinoma (n = 220), gastric cardiac adenocarcinoma (n = 277), or distal gastric adenocarcinoma (n = 441) diagnosed between 1992 and 1997, and 1,356 control participants in Los Angeles County. Unconditional polychotomous multivariable logistic regression analyses were done to evaluate the association between antacid drug use and these cancers.Results: Among participants who took nonprescription acid neutralizing agents for > 3 years, the odds ratio for esophageal adenocarcinoma was 6.32 compared with never users (95% confidence interval, 3.14-12.69; P-trend < 0.01). Analyses stratified by history of physician diagnosed upper gastrointestinal (UGI) disorders revealed a greater increase in esophageal adenocarcinoma risk associated with nonprescription antacid use among persons with no UGI disorder than among those with an UGI disorder (homogeneity of trends P = 0.07). Regular use of nonprescription acid neutralizing agents was not associated with risk of adenocarcinomas of the gastric cardia or distal stomach. Regular use of prescription acid suppressive drugs was not associated with risk for any of these cancers.Conclusion: We found risk of esophageal adenocarcinoma was greater among long-term nonprescription acid neutralizing drugs in participants without physician-diagnosed UGI conditions than among those with these conditions; this may represent self medication for undiagnosed precursor conditions or it may be that nonprescription acid neutralizing drugs, taken without limitation on amount used when symptoms are most intense, may permit alkaline bile reflux into the lower esophagus, thereby increasing esophageal adenocarcinoma risk. (Cancer Epidemiol Biomarkers Prev 2009;18(2):526-33)