August 24, 2018
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Treatment of gastroesophageal reflux disease decreases risk for esophageal adenocarcinoma

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Medical and surgical treatment of gastroesophageal reflux disease showed similar reductions in risk for esophageal adenocarcinoma, according to findings from a population-based cohort study.

“These findings support the hypothesis that antireflux medication and antireflux surgery are associated with reduced risk of esophageal adenocarcinoma in patients with gastroesophageal reflux disease [GERD],” John Maret-Ouda, MD, PhD, physician in the department of molecular medicine and surgery at Karolinska University Hospital in Stockholm, Sweden, and colleagues wrote.

GERD affects 10% to 20% of adults in Western populations and has been known to be an increased risk factor for esophageal adenocarcinoma.

Research on the association between antireflux medication and surgery and risk for esophageal adenocarcinoma has remained limited.

Therefore, Maret-Ouda and colleagues sought to determine whether antireflux surgery is associated with reduced risk for esophageal adenocarcinoma using both a background population and patients with GERD receiving only medication as comparison groups.

Researchers used health registries from Denmark, Finland, Iceland, Norway and Sweden to evaluate data from 942,906 patients with GERD who underwent antireflux surgery (n = 48,414; median age, 66 years; 56.1% men) or received antireflux medication only (n = 894,492; median age, 71 years; 51.4% women).

GERD was considered severe among 30,537 patients who underwent surgery and 264,543 who received medication alone.

Median follow-up was longer among patients who underwent surgery than patients who did not (12.7 years vs. 4.8 years); however, follow-up was longer among the nonsurgical subcohort with severe GERD (7 years).

Researchers observed 177 cases (0.4%) of esophageal adenocarcinoma among individuals who underwent antireflux surgery.

The risk for esophageal adenocarcinoma appeared high after surgery, but decreased over time.

At 5 to less than 10 years postsurgery, the standardized incidence ratio (SIR) was 7.63 (95% CI, 5.42-10.43) and 15 years after surgery, the SIR was 1.34 (95% CI, 0.98-1.8).

Among the cohort of individuals with severe GERD, 149 developed esophageal adenocarcinoma after surgery. The SIR for esophageal adenocarcinoma 5 to less than 10 years after surgery was 10.08 (95% CI, 6.98-14.09), and 15 years or more years after surgery, the SIR was 1.67 (95% CI, 1.15-2.35).

In the medication only group, 2,368 cases (0.3%) of esophageal adenocarcinoma occurred.

The SIRs increased after diagnosis but then decreased, from 2.06 (95% CI, 1.83-2.3) at 5 to 10 years of follow-up, to 0.69 (95% CI, 0.59-0.81) with 15 years of follow-up. For those with severe GERD, SIRs decreased from 3.9 (95% CI, 3.4-4.45) with 5 to 10 years of follow-up, to 1.16 (95% CI, 0.97-1.39) with 15 years or more of follow-up.

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Comparing risk for esophageal adenocarcinoma among patients who underwent surgery vs. patients who received medication only, HRs appeared stable from 5 to less than 10 years of follow-up (HR = 2.02; 95% CI, 1.44-2.84) to 15 years of follow-up (HR = 1.8; 95% CI, 1.28-2.54).

In analyses restricted to severe GERD, risk for esophageal adenocarcinoma remained stable, with an HR of 1.81 (95% CI, 1.24-2.63) at 5 to less than 10 years of follow-up, to 1.69 (95% CI, 1.14-2.51) at 15 years of follow-up.

“The risk estimates were stable over time in the comparison of patients with GERD undergoing operations with those receiving medication only, indicating a similar association of antireflux medication with risk of esophageal adenocarcinoma,” researchers wrote.

Researchers noted the findings appeared similar to previous meta-analyses that did not find a superior reduction in risk for cancer associated with antireflux surgery compared with antireflux medication among this patient population or among patients with Barrett esophagus.

“The higher risk estimates of esophageal adenocarcinoma after antireflux surgery compared

with medication only among patients with GERD are probably explained by patients who are selected for antireflux surgery having more severe and longer duration of GERD before surgery and therefore potentially having a higher risk of esophageal adenocarcinoma at baseline,” researchers wrote. – by Melinda Stevens

Disclosures: The authors report no relevant financial disclosures.