Temporal trends in new and recurrent oesophageal strictures in a Medicare population.
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.
El-Serag
H B
HB
Section of Gastroenterology, The Houston Department of Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA. hasheme@bcm.tmc.edu
Lau
M
M
D000368:Aged; D000369:Aged, 80 and over; D004940:Esophageal Stenosis / Q000209:etiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D017494:Proton Pumps / Q000627:therapeutic use*; D055502:Secondary Prevention
D017494:Proton Pumps