| 1. |
- Doorakkers, Eva, et al.
(författare)
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Early complications following oesophagectomy for cancer in relation to long-term healthcare utilisation: a prospective population-based cohort study
- 2015
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Ingår i: Plos One. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1932-6203.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little is known about how early postoperative complications after oesophagectomy for cancer influence healthcare utilisation in the long-term. We hypothesised that these complications also increase healthcare utilisation long after the recovery period. METHODS: This was a prospective, nationwide Swedish population-based cohort study of patients who underwent curatively intended oesophagectomy for cancer in 2001-2005 and survived at least 1 year postoperatively (n = 390). Total days of in-hospitalisation, number of hospitalisations and number of visits to the outpatient clinic within 5 years of surgery were analysed using quasi-Poisson models with adjustment for patient, tumour and treatment characteristics and are expressed as incidence rate ratios (IRR) and 95% confidence intervals (CI). RESULTS: There was an increased in-hospitalisation period 1-5 years after surgery in patients with more than 1 complication (IRR 1.5, 95% CI 1.0-2.4). The IRR for the number of hospitalisations by number of complications was 1.1 (95% CI 0.7-1.6), and 1.2 (95% CI 0.9-1.6) for number of outpatient visits in patients with more than 1 complication. The IRR for in-hospitalisation period 1-5 years following oesophagectomy was 1.8 (95% CI 1.0-3.0) for patients with anastomotic insufficiency and 1.5 (95% CI 0.9-2.5) for patients with cardiovascular or cerebrovascular complications. We found no association with number of hospitalisations (IRR 1.2, 95% CI 0.7-2.0) or number of outpatient visits (IRR 1.3, 95% CI 0.9-1.7) after anastomotic insufficiency, or after cardiovascular or cerebrovascular complications (IRR 1.2, 95% CI 0.7-1.9) and (IRR 1.1, 95% CI 0.8-1.5) respectively. CONCLUSION: This study showed an increased total in-hospitalisation period 1-5 years after oesophagectomy for cancer in patients with postoperative complications, particularly following anastomotic insufficiency.
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| 2. |
- Doorakkers, Eva, et al.
(författare)
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Eradication of Helicobacter pylori and gastric and oesophageal cancer : a systematic review and meta-analysis of cohort studies
- 2016
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Ingår i: Journal of the National Cancer Institute. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0027-8874 .- 1460-2105.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Helicobacter pylori (H. pylori) is associated with an increased risk of gastric adenocarcinoma and gastric mucosa associated lymphoid tissue (MALT) lymphoma, and a seemingly decreased risk of oesophageal adenocarcinoma. We aimed to assess how eradication therapy for H. pylori influences the risk of developing these cancers. Methods: This was a systematic review and meta-analysis. We searched PubMed, Web of Science, Embase and the Cochrane Library and selected articles that examined the risk of gastric cancer, MALT lymphoma or oesophageal cancer following eradication therapy, compared to a non-eradicated control group. Results: Among 3629 articles that were considered, 9 met the inclusion criteria. Of these, 8 cohort studies assessed gastric cancer, while 1 randomized trial assessed oesophageal cancer. Out of 12,899 successfully eradicated patients, 119 (0.9%) developed gastric cancer, compared to 208 (1.1%) out of 18,654 non-eradicated patients. The pooled relative risk of gastric cancer in all 8 studies was 0.46 (95% confidence interval 0.32-0.66, I2 32.3%) favouring eradication therapy. The 4 studies adjusting for time of follow-up and confounders showed a relative risk of 0.46 (95% confidence interval 0.29-0.72, I2 44.4%). Conclusion: This systematic review and meta-analysis indicates that eradication therapy for H. pylori prevents gastric cancer. There was insufficient literature for meta-analysis of MALT lymphoma or oesophageal cancer.
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| 3. |
- Doorakkers, Eva, et al.
(författare)
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Helicobacter pylori eradication in the Swedish population
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0036-5521 .- 1502-7708.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Helicobacter pylori (H. pylori) is associated with peptic ulcers and gastric cancer and its eradication aims to prevent these conditions. The recommended eradication regimen is triple therapy, consisting of a proton pump inhibitor in combination with clarithromycin and amoxicillin or metronidazole for 7 days. Yet, other antibiotic regimens are sometimes prescribed. We aimed to assess the use of eradication therapy for H. pylori in the Swedish population during the last decade. Materials and Methods: This population-based study used data from the Swedish Prescribed Drug Register. From July 2005 until December 2014, all regimens that can eradicate H. pylori were identified and evaluated according to patients’ age and sex and calendar year of eradication. Results: We identified 157,915 eradication episodes in 140,391 individuals (53.8% women, 42.6% older than 60 years), who correspond to 1.5% of the Swedish population. The absolute number and incidence of eradications decreased over the study period. Overall, 91.0% had 1 eradication and 0.1% had more than 3. Of all eradications, 95.4% followed the recommended regimen, while 4.7% did not. The latter group was overrepresented among individuals aged ≥80 years (7.8%). Amoxicillin and clarithromycin were most frequently prescribed, while metronidazole was rarely used (0.01%). Other prescribed antibiotics were ciprofloxacin (2.4%), doxycycline (1.4%), nitrofurantoin (0.7%), norfloxacin (0.5%) and erythromycin (0.3%). Conclusions: During the last decade in Sweden H. pylori eradication has been frequently prescribed, but the incidence of eradication has slowly declined. Most eradications followed the recommended regimen, including those occurring after a previous eradication.
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| 4. |
- Doorakkers, Eva, et al.
(författare)
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Helicobacter pylori eradication treatment and the risk of gastric adenocarcinoma in a Western population
- 2018
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Ingår i: Gut. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0017-5749 .- 1468-3288.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: Gastric infection with Helicobacter pylori is a strong risk factor for non-cardia gastric adenocarcinoma. The aim of this study was to assess whether the risk of gastric adenocarcinoma and non-cardia gastric adenocarcinoma decreases after eradication treatment for H. pylori in a Western population. DESIGN: This was a nationwide, population-based cohort study in Sweden in 2005-2012. Data from the Swedish Prescribed Drug Registry provided information on H. pylori eradication treatment, whereas information concerning newly developed gastric adenocarcinoma was retrieved from the Swedish Cancer Registry. The risk of gastric adenocarcinoma and non-cardia gastric adenocarcinoma in individuals who had received H. pylori eradication treatment was compared with the background population of the corresponding age, sex and calendar year distribution, yielding standardised incidence ratios (SIRs) with 95% CIs. RESULTS: During the follow-up of 95 176 individuals who had received eradication treatment (351 018 person-years at risk), 75 (0.1%) developed gastric adenocarcinoma and 69 (0.1%) developed non-cardia gastric adenocarcinoma. The risk of gastric adenocarcinoma decreased over time after eradication treatment to levels below that of the corresponding background population. The SIRs were 8.65 (95% CI 6.37 to 11.46) for 1-3 years, 2.02 (95% CI 1.25 to 3.09) for 3-5 years and 0.31 (95% CI 0.11 to 0.67) for 5-7.5 years after eradication treatment. When restricted to non-cardia adenocarcinoma, the corresponding SIRs were 10.74 (95% CI 7.77 to 14.46), 2.67 (95% CI 1.63 to 4.13) and 0.43 (95% CI 0.16 to 0.93). CONCLUSION: Eradication treatment for H. pylori seems to counteract the development of gastric adenocarcinoma and non-cardia gastric adenocarcinoma in this Western population.
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| 5. |
- Doorakkers, Eva
(författare)
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Helicobacter pylori eradication treatment and the risk of gastric and oesophageal cancer
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Helicobacter pylori is a strong and well-established risk factor for gastric cancer, but seems to decrease the risk of oesophageal adenocarcinoma. Thus, eradication treatment for Helicobacter pylori may decrease the risk of gastric cancer, and increase the risk of oesophageal adenocarcinoma. The aim of this thesis was to examine how eradication treatment influences the risk of these tumours in various settings and different study designs. Study I assessed the risk of gastric cancer after Helicobacter pylori eradication treatment in a systematic review and meta-analysis. Relevant literature was collected from PubMed, Web of Science, Embase and the Cochrane Library. The results of eight eligible cohort studies in predominantly Asian populations showed a risk decrease of more than 50% after eradication treatment for Helicobacter pylori (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.32-0.66). Study II described prescription patterns of Helicobacter pylori eradication treatment in the Swedish population based on nationwide data from the Prescribed Drug Registry. From 2005 to 2014 there were 140,391 individuals (1.5% of the Swedish population) receiving eradication treatment, with a decreasing use during the study period. Nearly all eradications (95.4%) used the standard triple therapy with a proton pump inhibitor and the antibiotics clarithromycin and amoxicillin, also for repeated eradication episodes (92.7%). Studies III and IV were Swedish nationwide, population-based cohort studies based on the Prescribed Drug Registry, Cancer Registry, Causes of Death Registry and the Patient Registry. The risks of gastric adenocarcinoma (Study III), as well as oesophageal adenocarcinoma, oesophageal squamous cell carcinoma and the premalignant condition Barrett’s oesophagus (Study IV) in the cohort of individuals who received Helicobacter pylori eradication treatment were compared to the risks in the corresponding Swedish general population. Study III showed a nearly 70% decrease in gastric adenocarcinoma risk from five years after eradication treatment (Standardised Incidence Ratio (SIR) 0.31, 95% CI 0.11-0.67), indicating that this treatment is effective also in a Western population. Study IV showed a decreased risk of oesophageal adenocarcinoma (SIR 0.17, 95% CI 0.00-0.92) and Barrett’s oesophagus (SIR 0.71, 95% CI 0.45-1.05) five years after eradication treatment, which was in contrast to the hypothesis. A decreasing trend was suggested also for oesophageal squamous cell carcinoma. In conclusion, this thesis has indicated that eradication treatment for Helicobacter pylori prevents gastric cancer development both in Asian populations and in the Swedish population. There was no evidence that eradication treatment increases the risk of oesophageal adenocarcinoma, Barrett’s oesophagus or oesophageal squamous cell carcinoma
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| 6. |
- Doorakkers, Eva, et al.
(författare)
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Why oesophageal adenocarcinoma is occurring more frequently
- 2015
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Ingår i: Nederlands Tijdschrift voor Geneeskunde. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0028-2162. ; 159, s. A8915-
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Tidskriftsartikel (refereegranskat)abstract
- Article in Dutch. The incidence of oesophageal adenocarcinoma has increased rapidly over the past decades in the Western world. The prognosis is poor with a mean 5-year survival rate of 19% in the Netherlands. Important risk factors that might account for this rising incidence are reflux, obesity and the absence of Helicobacter pylori. Oesophageal adenocarcinoma is 9 times more likely in men than in women. The reason for this much higher incidence of adenocarcinoma in men is still unclear, but sex hormones may play a role. De incidentie van het adenocarcinoom van de slokdarm is snel toegenomen in de westerse wereld in de laatste decennia. De prognose is slecht, met een gemiddelde 5-jaarsoverleving van 19% in Nederland. Belangrijke risicofactoren die verband kunnen houden met de stijgende incidentie zijn reflux, obesitas en de afwezigheid van Helicobacter pylori. Het adenocarcinoom van de slokdarm komt 9 keer zo vaak voor bij mannen als bij vrouwen. Het is nog onduidelijk waarom het adenocarcinoom zo veel meer voorkomt bij mannen. Mogelijk spelen geslachtshormonen hierbij een rol.
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