Je-Ming Hu1,2, Jia-Jheng Wu3, Chih-Hsiung Hsu3,4, Yong-Chen Chen5,6, Yu-Feng Tian7,8, Pi-Kai Chang1,2, Chao-Yang Chen2, Yu-Ching Chou3, Chien-An Sun9,10. 1. Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan. 2. Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan. 3. School of Public Health, National Defense Medical Center, Taipei City, Taiwan. 4. Teaching Office, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan. 5. Department of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. 6. Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. 7. Division of Colorectal Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan City, Taiwan. 8. Department of Health & Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan. 9. Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. 040866@mail.fju.edu.tw. 10. Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. 040866@mail.fju.edu.tw.
Abstract
PURPOSE: Several studies have investigated the association between gastroesophageal reflux disease (GERD) and colorectal cancer (CRC) risk, but the presented scientific results are highly debatable. This study examined the longitudinal association between GERD and CRC in an Asian population. METHODS: A retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. The study cohort comprised 45,828 individuals with newly diagnosed GERD (the GERD cohort) and 229,140 age, sex, and date of enrollment-matched patients without GERD (the comparison cohort) from 2000 to 2006. The primary outcome was the incidence of CRC. To estimate the effect of GERD on the risk of CRC, the Cox proportional hazards model was fitted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: There were 785 newly diagnosed CRC patients in the 45,828 patients with GERD. Relatively, there were 2375 incident CRC cases in 229,140 patients without GERD. The incidence rate of CRC for the GERD cohort (17.60 per 10,000 person-years) was significantly higher than the corresponding incidence rate for the comparison cohort (10.22 per 10,000 person-years). After adjustment for confounders, GERD was associated with a significantly increased risk of CRC (adjusted HR,1.76; 95% CI, 1.62-2.90). Of note, a significant association between GERD and CRC risk was evident in both genders. CONCLUSIONS: In conclusion, this nationwide population-based cohort study supports the hypothesis that GERD was associated with a significantly increased risk of CRC. Our findings warrant still further investigation of the underlying mechanisms related to carcinogenic effect of GERD on colorectal carcinoma.
PURPOSE: Several studies have investigated the association between gastroesophageal reflux disease (GERD) and colorectal cancer (CRC) risk, but the presented scientific results are highly debatable. This study examined the longitudinal association between GERD and CRC in an Asian population. METHODS: A retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. The study cohort comprised 45,828 individuals with newly diagnosed GERD (the GERD cohort) and 229,140 age, sex, and date of enrollment-matched patients without GERD (the comparison cohort) from 2000 to 2006. The primary outcome was the incidence of CRC. To estimate the effect of GERD on the risk of CRC, the Cox proportional hazards model was fitted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: There were 785 newly diagnosed CRC patients in the 45,828 patients with GERD. Relatively, there were 2375 incident CRC cases in 229,140 patients without GERD. The incidence rate of CRC for the GERD cohort (17.60 per 10,000 person-years) was significantly higher than the corresponding incidence rate for the comparison cohort (10.22 per 10,000 person-years). After adjustment for confounders, GERD was associated with a significantly increased risk of CRC (adjusted HR,1.76; 95% CI, 1.62-2.90). Of note, a significant association between GERD and CRC risk was evident in both genders. CONCLUSIONS: In conclusion, this nationwide population-based cohort study supports the hypothesis that GERD was associated with a significantly increased risk of CRC. Our findings warrant still further investigation of the underlying mechanisms related to carcinogenic effect of GERD on colorectal carcinoma.
Entities:
Keywords:
Colorectal cancer; Gastroesophageal reflux disease; National Health Insurance Research Database; Retrospective cohort study
Authors: Pieter J F de Jonge; Mark van Blankenstein; Caspar W N Looman; Mariël K Casparie; Gerrit A Meijer; Ernst J Kuipers Journal: Am J Gastroenterol Date: 2009-09-01 Impact factor: 10.864