The risk of oesophageal adenocarcinoma after gastrectomy for peptic ulcer disease

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 17 years, 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.