| 1. |
- Maret-Ouda, John, et al.
(författare)
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Opportunities for preventing esophageal adenocarcinoma
- 2016
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Ingår i: Cancer Prevention Research. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1940-6207. ; 9:11, s. 828-834
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Tidskriftsartikel (refereegranskat)abstract
- Esophageal adenocarcinoma is rapidly increasing in incidence in many Western societies, requires demanding treatment and is associated with a poor prognosis, therefore preventive measures are highly warranted. To assess the opportunities for prevention, we reviewed the available literature and identified seven main potentially preventive targets. Preventive effects were found based on medium level observational evidence following treatment of gastroesophageal reflux disease (both using medication and surgery) and tobacco smoking cessation, which should be clinically recommended among exposed patients. Non-steroidal anti-inflammatory drugs appears to prevent esophageal adenocarcinoma, and the limited existing data also indicates a protective effect of medication with statins or hormone replacement therapy in women, but current evidence is insufficient to guide clinical decision-making regarding these drugs. The evidence is presently insufficient to assess the potentially preventive role of weight loss. Whether avoidance of eradication of Helicobacter pylori prevents esophageal adenocarcinoma is not studied, but there is no evidence that such eradication increases symptoms of gastro- esophageal reflux or prevalence of erosive esophagitis. The introduction of preventive actions should be tailored towards high-risk individuals, i.e. older men with obesity and gastroesophageal reflux disease and individuals with Barrett’s esophagus rather than the population at large.
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| 2. |
- Ness-Jensen, Eivind, et al.
(författare)
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Lifestyle intervention in gastroesophageal reflux disease
- 2016
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Ingår i: Clinical Gastroenterology and Hepatology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1542-3565. ; 14:2, s. 175-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Gastroesophageal reflux disease (GERD) affects up to 30% of adults in Western populations and is increasing in prevalence. GERD is associated with lifestyle factors, particularly obesity and tobacco smoking, which also threatens the patient's general health. GERD carries the risk of several adverse outcomes and there is widespread use of potent acid-inhibitors, which are associated with long-term adverse effects. The aim of this systematic review was to assess the role of lifestyle intervention in the treatment of GERD. METHODS: Literature searches were performed in PubMed (from 1946), EMBASE (from 1980), and the Cochrane Library (no start date) to October 1, 2014. Meta-analyses, systematic reviews, randomized clinical trials (RCTs), and prospective observational studies were included. RESULTS: Weight loss was followed by decreased time with esophageal acid exposure in 2 RCTs (from 5.6% to 3.7% and from 8.0% to 5.5%), and reduced reflux symptoms in prospective observational studies. Tobacco smoking cessation reduced reflux symptoms in normal-weight individuals in a large prospective cohort study (odds ratio, 5.67). In RCTs, late evening meals increased time with supine acid exposure compared with early meals (5.2% point change), and head-of-the-bed elevation decreased time with supine acid exposure compared with a flat position (from 21% to 15%). CONCLUSIONS: Weight loss and tobacco smoking cessation should be recommended to GERD patients who are obese and smoke, respectively. Avoiding late evening meals and head-of-the-bed elevation is effective in nocturnal GERD.
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