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Survival after anti...
Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus : multinational cohort study
- Article/chapterEnglish2021
Publisher, publication year, extent ...
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2021-03-16
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Oxford University Press,2021
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LIBRIS-ID:oai:DiVA.org:uu-440102
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-440102URI
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https://doi.org/10.1093/bjs/znab024DOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:147294823URI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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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.Cconclusion: 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.
Subject headings and genre
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Santoni, GKarolinska Institutet
(author)
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Maret-Ouda, JohnKarolinska Institutet,Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital , Stockholm, Sweden
(author)
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Ness-Jensen, EKarolinska Institutet
(author)
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Färkkilä, M
(author)
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Lynge, E
(author)
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Pukkala, E
(author)
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Romundstad, P
(author)
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Tryggvadóttir, L
(author)
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-Chelpin, M von Euler
(author)
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Lagergren, JKarolinska Institutet
(author)
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Karolinska InstitutetCentrum för klinisk forskning i Sörmland (CKFD)
(creator_code:org_t)
Related titles
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In:British Journal of Surgery: Oxford University Press108:7, s. 864-8700007-13231365-2168
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Yanes, M
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Santoni, G
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Maret-Ouda, John
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Ness-Jensen, E
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Färkkilä, M
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Lynge, E
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Pukkala, E
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Romundstad, P
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Tryggvadóttir, L
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-Chelpin, M von ...
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Lagergren, J
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
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Uppsala University
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Karolinska Institutet