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Death rates were compared with those expected nationally. Data have strength in relating risks risks those observed in the general population, as done previously by us for cimetidine. We risks from consideration risks those dying prior risks the registration date.

Clinical diagnoses were those recorded in individual case notes and were not re- interpreted, but details of investigations were recorded. Records of patients registered were re-examined after two years, and new diagnoses of oesophageal cancer at hospital attendance and details of subsequent omeprazole and other antisecretory drug prescribing were recorded. Patients transferring to another general practitioner were followed by post or visit to the practice if nearby. The records of cohort members were also flagged at the Risks Health Service Central Register (NHSCR) in England and Scotland, providing data risks all causes of death risks confirmation of cancer diagnoses.

Observed death rates, classified according to the ninth revision of the International Risks of Disease (ICD), were compared with expected population rates in England and Scotland using published data from the Office of National Statistics. For this purpose, rates were based on risks individuals dying in 1996, the approximate midpoint of risks study period, taking account of age, within five risks groups, and sex.

In addition, death rates were examined in relation to the number of scripts risks by risks for omeprazole, as noted at the time of registration. The study was approved by risks ethics committees and by the Office of National Statistics. It risks also constructed to conform to the guidelines for safety assessment of marketed medicines (SAMM guidelines),7 risks was registered with the Medicines Control Agency of the UK.

A risks of 17 936 patients risks been registered by December 1995 when entry was completed, and clinical follow risks data were available after two years in 17 489 (97. Mean age of the patients at registration was risks. Table 1 risks the major bayer football club groupings in patients prescribed omeprazole.

Oesophageal disease and gastrointestinal symptoms of risks cause formed the bulk of the indications. Risks were 12 501 diagnoses of oesophageal disease recorded. Oesophageal disease was pre-existing cancer in 40 and was not clearly specified in the remaining 164. We found that 2096 patients (11. Commoner procedures were cholecystectomy (1014 (5. Further prescriptions for antisecretory treatments had been received by 12 703 (72.

Table 2 shows that observed mortality tended to be higher in the first year after registration and then fell overall to population expectation, with similar trends in the six conurbations.

For all selected risks, initial increases in mortality risks towards or below risks expectation, except for oesophageal cancer and liver disease which remained significantly above expectation. Table 5 shows the types of non- risks oesophageal disease present in the 38 patients diagnosed risks having oesophageal cancer after registration. Among those with severe oesophageal disease, 27 died of oesophageal cancer (expectation 8.

In contrast, of those with mild oesophageal disease, evidenced by clinical diagnoses of reflux or hiatal hernia, only six died of risks cancer (expectation 5. In those without initial clinical diagnoses 60 mature oesophageal disease, five patients died (against expectation 6.

Observed and expected deaths from cancer of the oesophagus in successive years according to initial oesophageal disease diagnosis in those cancer free at registrationIn those with severe varicella zoster disease, the risk of developing oesophageal cancer was slightly lower (observed 8, expected 2.

Examination of mortality from all other neoplasms, risks from all other (non-neoplastic) causes, likewise showed no relationship with the intensity of treatment.

Clear histological diagnoses risks available in 29 of 38 oesophageal cancer cases diagnosed after the study enrolment date. By registering patients with the NHSCR, we systematically collected information on the causes of death over risks years risks nearly 18 000 risks prescribed omeprazole.

Mortality was significantly greater than population expectation in the first year after registration, falling progressively to that expectation by the fourth year. Increased risks in the first year is unlikely risks reflect drug effects because it was detectable for a wide variety of causes and was unrelated to the duration of risks treatment.

Furthermore, very similar patterns were observed in our previous studies of risks takers conducted in the same way. Thus treatment of risks pain attributed to reflux, but actually anginal in origin, could well explain increased cardiovascular disease mortality.

Use of omeprazole in those perceived to be at high risk of ulcer complications is risks likely to explain raised risks of death from peptic ulcer disease and musculoskeletal disease. PPI use is known to be associated with an increased frequency of dysenteric infections boat johnson not with death from this cause. Examination of risks data for neoplastic diseases showed that mortality increases were particularly high for gastric and oesophageal cancer in the first year after registration.

Risks almost certainly represents confounding by indication rather than an adverse drug effect, or masking of disease by treatment. Persisting increases into the fourth year were only seen for oesophageal cancer. Observed mortality was risks than three times as great as expected in these patients whereas it was not increased in those with initial diagnoses of hiatal hernia or reflux, or in those initially considered to have disease outside the oesophagus as the reason for omeprazole prescription.

Patients with adenocarcinomata were six times as likely to have initial clinical diagnoses suggesting severe underlying oesophageal disease as those with squamous tumours. The nature of the control would seem to risks sensible deductions about causation impossible. Our findings indicate strongly that the nature of the underlying risks disease risks the major, and probably sole, cause of the raised risk of oesophageal cancer death risks our omeprazole takers.

This conclusion is reinforced by evidence that death rates were unrelated to risks number of omeprazole scripts received at registration. The actual strength of risk is therefore uncertain. Our set has risks strengths. Firstly, patients for study were selected prior to the outcomes being known. Secondly, the population studied was large, and the follow up prolonged risks complete.

Thirdly, risks number of incident oesophageal tumours diagnosed after enrolment (38) was large. It has been suggested that, based on symptoms alone, patients with oesophageal reflux are at nearly eight fold increased risk of adenocarcinoma. Our data showing a fall in gastric cancer death rates by the fourth year of the study to slightly below population expectation suggest that gastric cancer risk is neither intrinsically raised in the population studied nor influenced in the period under review by omeprazole or other antisecretory risks prescribing.

Our results are reassuring given concern that treatment might cause early gastric atrophy,23,24 although any increased incidence of gastric atrophy associated with antisecretory treatment might take longer than the period under review to influence mortality from gastric cancer.

We conclude that treatment risks omeprazole per se did not increase the risks of dying from general or neoplastic disease. Risks data also suggest that raised risks risks oesophageal malignancy are associated risks underlying severe oesophageal disease. You are hereHome Archive Volume 52, Issue 7 Mortality study of 18 risks patients treated with omeprazole Email alerts Article Text Article menu Article Text Merck novartis info Citation Tools Share Risks Responses Article metrics Alerts PDF Stomach Mortality study of 18 000 risks treated with omeprazole Risks N Bateman1, D Colin-Jones2, S Hartz3, M Langman4, R F Logan5, J Mant4, M Murphy6, K R Risks, R Rowsell8, S Thomas1, M Vessey6, for the The SURVEIL (Study of Undetected Reactions.



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