建议对Barrett食管患者进行抗反流治疗以减少食管腺癌的发生。抗反流手术（反流中心修补术）对所有类型的致癌胃内容物引起的胃食管反流起到反作用，且比抗反流药物（质子泵抑制剂）更有效地减少食管酸暴露。我们检验了抗反流手术在Barrett食管患者中较抗反流药物更大程度地预防食管腺癌的假设。这项跨国和基于人群的队列研究包括丹麦（2012-2020）、芬兰（1987-1996和2010-2020）、挪威（2008-2020）或瑞典（2006-2020）国家患者登记中的所有Barrett食管诊断患者。将接受抗反流手术的患者与使用抗反流药物的非手术患者进行比较。使用多变量Cox回归计算食管腺癌风险，提供调整后的风险比（HR）和95%置信区间（CI），调整因素包括年龄、性别、国家、日历年和合并症。该队列包括33,939名Barrett食管患者。其中，542人（1.6%）接受了抗反流手术。在长达32年的随访期内，与使用抗反流药物的非手术患者相比，接受抗反流手术的患者整体HR并未下降，而是增加（调整HR 1.9, 95% CI 1.1-3.5）。此外，对于每个随访类别，HR并未随随访时间延长而降低，反而呈增加趋势，从1-4年的随访内的HR为1.8（95% CI 0.6-5.0）到10-32年的随访后的HR为4.4（95% CI 1.4-13.5）。Barrett食管患者接受抗反流手术似乎并不比使用抗反流药物的患者具有更低的食管腺癌风险。版权所有 © 2023 AGA Institute. Elsevier公司所有，保留所有权利。

Antireflux treatment is recommended to reduce esophageal adenocarcinoma in patients with Barrett's esophagus. Antireflux surgery (fundoplication) counteracts gastroesophageal reflux of all types of carcinogenic gastric content, and reduces esophageal acid exposure to a greater extent than antireflux medication (proton pump inhibitors). We examined the hypothesis that antireflux surgery prevents esophageal adenocarcinoma to a larger degree than antireflux medication in patients with Barrett's esophagus.This multi-national and population-based cohort study included all patients with a diagnosis of Barrett's esophagus in any of the national patient registries in Denmark (2012-2020), Finland (1987-1996 and 2010-2020), Norway (2008-2020), or Sweden (2006-2020). Patients who underwent antireflux surgery were compared with non-operated patients using antireflux medication. The risk of esophageal adenocarcinoma was calculated using multivariable Cox regression, providing hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex, country, calendar year, and comorbidity.The cohort consisted of 33,939 patients with Barrett's esophagus. Of these, 542 (1.6%) had undergone antireflux surgery. During up to 32 years of follow-up, the overall HR was not decreased in patients having undergone antireflux surgery compared to non-operated patients using antireflux medication but rather increased (adjusted HR 1.9, 95% CI 1.1-3.5). Additionally, HRs did not decrease with longer follow-up, but instead increased for each follow-up category, from 1.8 (95% CI 0.6-5.0) within 1-4 years of follow-up to 4.4 (95% CI 1.4-13.5) after 10-32 years of follow-up.Patients with Barrett's esophagus who undergo antireflux surgery do not seem to have a lower risk of esophageal adenocarcinoma than those using antireflux medication.Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.