Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study
Background The aim was to examine the hypothesis that antireflux surgery with fundoplication improves long-term survival compared with antireflux medication in patients with reflux oesophagitis or Barrett’s oesophagus. Method Individuals aged between 18 and 70 years with reflux oesophagitis or Barre...
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2021
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Online Access: | https://hdl.handle.net/11250/2984252 https://doi.org/10.1093/bjs/znab024 |
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ftntnutrondheimi:oai:ntnuopen.ntnu.no:11250/2984252 2023-05-15T16:52:23+02:00 Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study Yanes, M. Santoni, Giola Maret-Ouda, John Ness-Jensen, E. Färkkilä, Martti Lynge, Elsebeth Pukkala, Eero Romundstad, P. Tryggvadottir, Laufey -Chelpin, M von Euler Lagergren, Jesper 2021 application/pdf https://hdl.handle.net/11250/2984252 https://doi.org/10.1093/bjs/znab024 eng eng Oxford University Press British Journal of Surgery. 2021, 108 (7), 864-870. urn:issn:0007-1323 https://hdl.handle.net/11250/2984252 https://doi.org/10.1093/bjs/znab024 cristin:1931631 This is the authors' accepted manuscript to an article published by Oxford University Press 864-870 108 British Journal of Surgery 7 Peer reviewed Journal article 2021 ftntnutrondheimi https://doi.org/10.1093/bjs/znab024 2022-03-16T23:38:51Z Background The aim was to examine the hypothesis that antireflux surgery with fundoplication improves long-term survival compared with antireflux medication in patients with reflux oesophagitis or Barrett’s oesophagus. Method Individuals aged between 18 and 70 years with reflux oesophagitis or Barrett’s oesophagus (intestinal metaplasia) documented from in-hospital and specialized outpatient care were selected from national patient registries in Denmark, Finland, Iceland, and Sweden from 1980 to 2014. The study investigated all-cause mortality and disease-specific mortality, comparing patients who had undergone open or laparoscopic antireflux surgery with fundoplication versus those using antireflux medication. Multivariable Cox regression analysis was used to estimate hazard ratios (HRs) with 95 per cent confidence intervals for all-cause mortality and disease-specific mortality, adjusted for sex, age, calendar period, country, and co-morbidity. Results Some 240 226 patients with reflux oesophagitis or Barrett’s oesophagus were included, of whom 33 904 (14.1 per cent) underwent antireflux surgery. The risk of all-cause mortality was lower after antireflux surgery than with use of medication (HR 0.61, 95 per cent c.i. 0.58 to 0.63), and lower after laparoscopic (HR 0.56, 0.52 to 0.60) than open (HR 0.80, 0.70 to 0.91) surgery. After antireflux surgery, mortality was decreased from cardiovascular disease (HR 0.58, 0.55 to 0.61), respiratory disease (HR 0.62, 0.57 to 0.66), laryngeal or pharyngeal cancer (HR 0.35, 0.19 to 0.65), and lung cancer (HR 0.67, 0.58 to 0.80), but not from oesophageal cancer (HR 1.05, 0.87 to 1.28), compared with medication, The decreased mortality rates generally remained over time. Conclusion In patients with reflux oesophagitis or Barrett’s oesophagus, antireflux surgery is associated with lower mortality from all causes, cardiovascular disease, respiratory disease, laryngeal or pharyngeal cancer, and lung cancer, but not from oesophageal cancer, compared with antireflux medication. acceptedVersion Article in Journal/Newspaper Iceland NTNU Open Archive (Norwegian University of Science and Technology) British Journal of Surgery 108 7 864 870 |
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NTNU Open Archive (Norwegian University of Science and Technology) |
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ftntnutrondheimi |
language |
English |
description |
Background The aim was to examine the hypothesis that antireflux surgery with fundoplication improves long-term survival compared with antireflux medication in patients with reflux oesophagitis or Barrett’s oesophagus. Method Individuals aged between 18 and 70 years with reflux oesophagitis or Barrett’s oesophagus (intestinal metaplasia) documented from in-hospital and specialized outpatient care were selected from national patient registries in Denmark, Finland, Iceland, and Sweden from 1980 to 2014. The study investigated all-cause mortality and disease-specific mortality, comparing patients who had undergone open or laparoscopic antireflux surgery with fundoplication versus those using antireflux medication. Multivariable Cox regression analysis was used to estimate hazard ratios (HRs) with 95 per cent confidence intervals for all-cause mortality and disease-specific mortality, adjusted for sex, age, calendar period, country, and co-morbidity. Results Some 240 226 patients with reflux oesophagitis or Barrett’s oesophagus were included, of whom 33 904 (14.1 per cent) underwent antireflux surgery. The risk of all-cause mortality was lower after antireflux surgery than with use of medication (HR 0.61, 95 per cent c.i. 0.58 to 0.63), and lower after laparoscopic (HR 0.56, 0.52 to 0.60) than open (HR 0.80, 0.70 to 0.91) surgery. After antireflux surgery, mortality was decreased from cardiovascular disease (HR 0.58, 0.55 to 0.61), respiratory disease (HR 0.62, 0.57 to 0.66), laryngeal or pharyngeal cancer (HR 0.35, 0.19 to 0.65), and lung cancer (HR 0.67, 0.58 to 0.80), but not from oesophageal cancer (HR 1.05, 0.87 to 1.28), compared with medication, The decreased mortality rates generally remained over time. Conclusion In patients with reflux oesophagitis or Barrett’s oesophagus, antireflux surgery is associated with lower mortality from all causes, cardiovascular disease, respiratory disease, laryngeal or pharyngeal cancer, and lung cancer, but not from oesophageal cancer, compared with antireflux medication. acceptedVersion |
format |
Article in Journal/Newspaper |
author |
Yanes, M. Santoni, Giola Maret-Ouda, John Ness-Jensen, E. Färkkilä, Martti Lynge, Elsebeth Pukkala, Eero Romundstad, P. Tryggvadottir, Laufey -Chelpin, M von Euler Lagergren, Jesper |
spellingShingle |
Yanes, M. Santoni, Giola Maret-Ouda, John Ness-Jensen, E. Färkkilä, Martti Lynge, Elsebeth Pukkala, Eero Romundstad, P. Tryggvadottir, Laufey -Chelpin, M von Euler Lagergren, Jesper Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study |
author_facet |
Yanes, M. Santoni, Giola Maret-Ouda, John Ness-Jensen, E. Färkkilä, Martti Lynge, Elsebeth Pukkala, Eero Romundstad, P. Tryggvadottir, Laufey -Chelpin, M von Euler Lagergren, Jesper |
author_sort |
Yanes, M. |
title |
Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study |
title_short |
Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study |
title_full |
Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study |
title_fullStr |
Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study |
title_full_unstemmed |
Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study |
title_sort |
survival after antireflux surgery versus medication in patients with reflux oesophagitis or barrett's oesophagus: multinational cohort study |
publisher |
Oxford University Press |
publishDate |
2021 |
url |
https://hdl.handle.net/11250/2984252 https://doi.org/10.1093/bjs/znab024 |
genre |
Iceland |
genre_facet |
Iceland |
op_source |
864-870 108 British Journal of Surgery 7 |
op_relation |
British Journal of Surgery. 2021, 108 (7), 864-870. urn:issn:0007-1323 https://hdl.handle.net/11250/2984252 https://doi.org/10.1093/bjs/znab024 cristin:1931631 |
op_rights |
This is the authors' accepted manuscript to an article published by Oxford University Press |
op_doi |
https://doi.org/10.1093/bjs/znab024 |
container_title |
British Journal of Surgery |
container_volume |
108 |
container_issue |
7 |
container_start_page |
864 |
op_container_end_page |
870 |
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1766042582710747136 |