THE AGE-RELATED INCIDENCES OF ESOPHAGEAL-CARCINOMA IN INTELLECTUALLY DISABLED INDIVIDUALS IN INSTITUTES IN THE NETHERLANDS

Objective: An increased age-related incidence of oesophageal cancer in people with intellectual disability has been suggested by studies in the Netherlands. Gastrooesophageal reflux disease (CORD), as documente d by pH testing, occurs frequently in the intellectually disabled popu lation, being found in nearly 50% of those with an IQ less than 50, wh ile Barrett's oesophagus is found in about 15-26%. Design: We compared the age-related incidence of oesophageal cancer in institutionalized, intellectually disabled individuals in the Netherlands with the age-r elated incidence in the general Dutch population. Methods: Data were p rovided by the Netherlands Cancer Registry. The patient's institute ph ysician was asked to complete a questionnaire about the diagnosis, whi ch was endoscopically and histologically confirmed. Results: The incid ence of oesophageal carcinoma was 20 in 168 000 person-years. The expe cted incidence for oesophageal cancer, based on age-related incidence in the general population, was 7.0, resulting in a standardized morbid ity ratio in the population with intellectual disability of 2.9 (confi dence limits, 1.8-4.1; P<0.001). Endoscopic findings were as follows: in 18/20 intellectually disabled carcinoma patients an adenocarcinoma was found; the remaining two patients had a squamous cell carcinoma. B arrett's epithelium was observed in nine patients (45%), eight (42%) o f whom showed a peptic stricture as well. In 15 (75%) cancer patients reflux oesophagitis was found, accompanied in 14 cases by a hiatal her nia. Conclusion: A standardized morbidity ratio for oesophageal carcin oma of 2.9 was found in the intellectually disabled population as comp ared to the general population. Early detection and treatment of CORD in the population with intellectual disability is of paramount importa nce to prevent the development of Barrett's dysplasia and carcinoma.