Trends in New and Recurrent Oesophageal Strictures in a Medicare Populace
Trends in New and Recurrent Oesophageal Strictures in a Medicare Populace
Background: The widespread use of proton pump inhibitors for gastro-oesophageal reflux disease could result in a decline in new as well as recurrent gastro-oesophageal reflux disease-related oesophageal strictures. The temporal trends of strictures have not been examined in population-based studies.
Methods: To examine the temporal trends in strictures, we calculated the age-adjusted incidence rates of new oesophageal strictures with or without oesophageal dilation in a sample of Medicare beneficiaries between 1992 and 2000. We also examined recurrent dilations recorded at least 3 months after a new stricture or the preceding recurrent stricture.
Results: The age-adjusted rates for strictures accompanied with dilation declined by approximately 11% from 215 per million to 192 per million. New oesophageal strictures with dilation declined as a proportion of all upper endoscopies procedures (from 2.6% to 1.9%). Recurrent dilation within 1 year declined dramatically from 16% (9.5% CI: 12.5–20.3) in 1992 to 8% (95% CI: 4.43–10.62) in 2000. In multivariable proportional hazards model, there was a 30% risk reduction of recurrent oesophageal strictures.
Conclusions: This population-based study indicates that the incidence of new as well as recurrent oesophageal strictures has been declining. In the face of rising incidence of other gastro-oesophageal reflux disease-related complications, it is important to understand the explanation of the present observations.
Oesophageal strictures are known complications of gastro-oesophageal reflux disease (GERD). In the presence of obstructive symptoms, oesophageal strictures are treated with oesophageal dilation. Without gastric acid suppression, most GERD-related oesophageal strictures recur after dilation. Proton pump inhibitors (PPIs) have been shown in randomized as well as non-randomized clinical trials to reduce the recurrence rate of oesophageal strictures after dilation when compared with controls treated with histamine-2 receptor antagonists. However, it remains unclear whether acid suppression in patients with GERD prevents the development of new oesophageal strictures.
The widespread use of PPIs could have led to the decline in new as well as recurrent oesophageal strictures. However, few studies have examined the temporal trends of oesophageal strictures examined by few studies, and none of the studies was population-based. A study by Guda and Vakil who examined the records of two community hospitals in the United States for temporal trends on dilation procedures reported a decline between 1986 and 2001. The proportion of patients undergoing oesophageal dilation increased between 1998 and 2001. We recently examined temporal trends of oesophageal strictures in the Department of Veterans Affairs between 1998 and 2003 and found a decline (36%) in recurrent stricture, but no impressive change in new strictures. Our previous study was limited by its non-population-based nature, restriction to veterans (mostly men), and the relatively short time period in which trends were examined. One additional limitation is that the diffusion of PPIs might have reached a plateau by 1998. The findings of these studies may not be representative of trends in the general population. We therefore examined the incidence of new as well as recurrent oesophageal strictures in a sample representing approximately 5% of the Medicare enrolled individuals in the United States.
Summary and Background
Summary
Background: The widespread use of proton pump inhibitors for gastro-oesophageal reflux disease could result in a decline in new as well as recurrent gastro-oesophageal reflux disease-related oesophageal strictures. The temporal trends of strictures have not been examined in population-based studies.
Methods: To examine the temporal trends in strictures, we calculated the age-adjusted incidence rates of new oesophageal strictures with or without oesophageal dilation in a sample of Medicare beneficiaries between 1992 and 2000. We also examined recurrent dilations recorded at least 3 months after a new stricture or the preceding recurrent stricture.
Results: The age-adjusted rates for strictures accompanied with dilation declined by approximately 11% from 215 per million to 192 per million. New oesophageal strictures with dilation declined as a proportion of all upper endoscopies procedures (from 2.6% to 1.9%). Recurrent dilation within 1 year declined dramatically from 16% (9.5% CI: 12.5–20.3) in 1992 to 8% (95% CI: 4.43–10.62) in 2000. In multivariable proportional hazards model, there was a 30% risk reduction of recurrent oesophageal strictures.
Conclusions: This population-based study indicates that the incidence of new as well as recurrent oesophageal strictures has been declining. In the face of rising incidence of other gastro-oesophageal reflux disease-related complications, it is important to understand the explanation of the present observations.
Background
Oesophageal strictures are known complications of gastro-oesophageal reflux disease (GERD). In the presence of obstructive symptoms, oesophageal strictures are treated with oesophageal dilation. Without gastric acid suppression, most GERD-related oesophageal strictures recur after dilation. Proton pump inhibitors (PPIs) have been shown in randomized as well as non-randomized clinical trials to reduce the recurrence rate of oesophageal strictures after dilation when compared with controls treated with histamine-2 receptor antagonists. However, it remains unclear whether acid suppression in patients with GERD prevents the development of new oesophageal strictures.
The widespread use of PPIs could have led to the decline in new as well as recurrent oesophageal strictures. However, few studies have examined the temporal trends of oesophageal strictures examined by few studies, and none of the studies was population-based. A study by Guda and Vakil who examined the records of two community hospitals in the United States for temporal trends on dilation procedures reported a decline between 1986 and 2001. The proportion of patients undergoing oesophageal dilation increased between 1998 and 2001. We recently examined temporal trends of oesophageal strictures in the Department of Veterans Affairs between 1998 and 2003 and found a decline (36%) in recurrent stricture, but no impressive change in new strictures. Our previous study was limited by its non-population-based nature, restriction to veterans (mostly men), and the relatively short time period in which trends were examined. One additional limitation is that the diffusion of PPIs might have reached a plateau by 1998. The findings of these studies may not be representative of trends in the general population. We therefore examined the incidence of new as well as recurrent oesophageal strictures in a sample representing approximately 5% of the Medicare enrolled individuals in the United States.