title: Environmental risk factors in the development of adenocarcinoma of the oesophagus or gastric cardia: a cross-sectional study in a Dutch cohort.
abstract: BACKGROUND
  Risk factors for adenocarcinoma of the oesophagus (OAC) and gastric cardia (GCA) are not yet established.
  
  
  OBJECTIVE
  To compare environmental risk factors between patients with OAC and GCA.
  
  
  METHODS
  One-hundred and twenty-six patients with OAC, 43 with GCA and 57 with squamous cell carcinoma filled out a questionnaire with information on demographic and lifestyle characteristics, physical activity levels, family history, gastro-oesophageal reflux disease symptoms and medication use.
  
  
  RESULTS
  OAC and GCA patients were similar with regard to male predominance and age, alcohol intake and smoking, use of fruits and vegetables, body posture and occupational activities (P > 0.05). GCA patients less often had heartburn compared with OAC patients [odds ratio (OR) 0.5, 95% confidence interval (CI) 0.2-0.96] and had these symptoms less frequently and for a shorter period (OR 0.3, CI 0.1-1.0 and OR 0.1, CI 0.03-0.6, respectively). Former and current aspirin use was lower among GCA patients than OAC patients (OR 0.2, CI 0.05-0.7 and OR 0.4, CI 0.1-0.9, respectively), whereas no difference in non-steroidal anti-inflammatory drug use was detected.
  
  
  CONCLUSIONS
  Although OAC and GCA share several environmental risk factors, OAC is more frequently associated with a history of gastro-oesophageal reflux disease, suggesting a more important role for gastro-oesophageal reflux in OAC compared with GCA.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. p.dejonge@erasmusmc.nl
authors.forename: P J F
authors.initials: PJ
authors.lastname: DE Jonge
authors.forename: L M M
authors.initials: LM
authors.lastname: Wolters
authors.forename: E W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: H
authors.initials: H
authors.lastname: VAN Dekken
authors.forename: J G
authors.initials: JG
authors.lastname: Kusters
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology*; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet; D004777:Environment; D004938:Esophageal Neoplasms / Q000209:etiology*; D015444:Exercise / Q000502:physiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000209:etiology*