Reflux disease manifests as acid regurgitation and heartburn and is a known risk factor for esophageal cancer. However, a new study published in The BMJ by researchers at Karolinska Institutet now reports that the majority of patients do not have a higher risk of cancer. A large-scale study from three Nordic countries shows that the cancer risk is only elevated in patients whom gastroscopy reveals to have changes in the esophageal mucosa.
“This is a gratifying result since reflux disease is a very common condition and most patients are found to have a completely normal mucus membrane on gastroscopic examination,” says the study’s first author Dag Holmberg, researcher at the Department of Molecular Medicine and Surgery, Karolinska Institutet and resident doctor of surgery at Karolinska University Hospital in Sweden.
In reflux disease, acidic stomach contents leak into the esophagus. This can sometimes cause inflammation in the esophageal mucus membrane (esophagitis), which is diagnosed via gastroscopy. It is common knowledge that reflux disease increases the risk of esophageal cancer, but what the cancer risk is for patients with normal mucosa has remained unknown.
The symptoms of reflux disease can come and go but generally persist, which means that many patients frequently seek medical attention and often undergo repeated gastroscopies to detect mucosal lesions or prodromal cancer.
“Our study suggests that these repeated gastroscopies are probably unnecessary for people with reflux disease who have a normal esophageal mucosa,” says Dr. Holmberg. “These findings should be reassuring for this large patient group and can guide GPs who often treat them.”
The present study is based on national health data registries in Sweden, Denmark and Finland, and included over 285,000 individuals with reflux disease and no gastroscopic evidence of esophagitis. The patients were followed for up to 31 years and the researchers registered all cases of esophageal cancer.
The cancer risk was then compared with that for individuals from the general population matched by age and sex and at the same period in the three countries. No increased risk of esophageal cancer was observed in patients with reflux disease and a normal mucus membrane.
By way of comparison, the researchers also analyzed the cancer risk in over 200,000 individuals with reflux disease and esophagitis. These people were at a clearly increased relative risk of developing esophageal cancer.
“We now intend to examine what factors other than esophagitis can be linked to tumor growth in people with reflux disease,” says the study’s last author Jesper Lagergren, professor of surgery at the Department of Molecular Medicine and Surgery, Karolinska Institutet, and consultant surgeon at Karolinska University Hospital.
The study was a collaboration between researchers at Karolinska Institutet and Karolinska University Hospital in Sweden, the University of Copenhagen in Denmark, and the universities of Helsinki and Oulu in Finland.
Dag Holmberg et al., Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma: population-based cohort study in three Nordic countries, The BMJ (2023). DOI: 10.1136/bmj-2023-076017
British Medical Journal (BMJ)
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