Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma
- Study type
- Observational study
- Design
- Nationwide population-based case–control study (Sweden)
- Sample size
- 189 patients with oesophageal adenocarcinoma, 262 patients with cardia adenocarcinoma, 167 patients with oesophageal squamous cell carcinoma and 820 controls from the general population
- Source
- N Engl J Med · 1999
In plain words
In this study in Sweden, people who had repeated symptoms of reflux (stomach acid coming back up, or heartburn) were much more likely than others to have developed a particular type of oesophageal (food pipe) cancer called adenocarcinoma. The more frequent, severe and long-lasting the symptoms, the higher the risk. The link between reflux and cancer where the oesophagus joins the stomach (the cardia) was weaker, and no link was seen with the squamous cell type of oesophageal cancer. If you have persistent or severe reflux symptoms, talk to your doctor about tests and follow-up.
Key results
Treatment arms and regimens
Patients with oesophageal adenocarcinoma, gastric cardia adenocarcinoma and oesophageal squamous cell carcinoma. This was an observational study with no therapeutic intervention.
820 controls from the general population. This was an observational study with no therapeutic intervention.
Source of the regimen details: Abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Eligible patients in Sweden between 1995 and 1997 (529 eligible patients); of these, 189 patients with oesophageal adenocarcinoma and 262 patients with cardia adenocarcinoma were interviewed, representing 85% of eligible patients. For comparison, 820 controls from the general population and 167 patients with oesophageal squamous cell carcinoma were also interviewed.
Endpoints
Association of a history of gastro-oesophageal reflux (based on in-person interviews) with the risk of oesophageal adenocarcinoma and cardia adenocarcinoma, with odds ratios calculated by logistic regression and multivariable adjustment for potential confounders.
Safety and side effects
This is an observational study and no treatment safety data (grade ≥3 adverse events) are reported.
Clinical significance and place in guidelines
This study provided strong evidence for an association between symptomatic reflux and oesophageal adenocarcinoma, and showed that the association is weaker for cardia adenocarcinoma and absent for oesophageal squamous cell carcinoma. The abstract does not comment on direct changes to clinical guidelines or screening; the status of guideline recommendations should be checked separately.
Limitations
The design is case–control and reflux information was collected by interview; recall bias and residual confounding are therefore possible. The authors stated their conclusion about a causal relationship with the word “probably”. 85% of eligible patients were interviewed.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.