Erosive GORD raises cancer risk

3 minute read

But the good news is that the risk of oesophageal cancer is no higher in people with non-erosive disease, research suggests.

Erosive gastro-oesophageal reflux disease more than doubles the risk of oesophageal cancer compared with non-erosive reflux.

A study of almost 500,000 Scandinavian adults found the rate of oesophageal adenocarcinoma in patients with non-erosive GORD was similar to that of the general population, at 11 per 100,000 after a follow-up of six years.

That incidence didn’t change at follow-up intervals up to 31 years, according to the data from national health registries in Denmark, Finland and Sweden.

But for people with erosive oesophagitis, after a median follow-up period of 7.8 years, the rate of oesophageal adenocarcinoma was 31 per 100,000.

The increased risk became even more pronounced with longer follow-up. the researchers said.

“This finding suggests that patients with confirmed non-erosive GORD are not susceptible to develop oesophageal adenocarcinoma and may not require repeated endoscopic examinations regarding assessment of cancer risk,” they wrote in the BMJ.

“The finding may represent a shift in how to consider patients’ risk of tumour development based on endoscopic GORD phenotype, where patients with non-erosive GORD may be treated as the general population, whereas those with erosive GORD might benefit from being re-assessed.”

“Physicians do not need to consider referring patients with GORD with a previous normal upper endoscopy for repeat endoscopy unless they develop warning symptoms of oesophageal adenocarcinoma, mainly dysphagia, as recommended for all individuals.

“This message contrasts with today’s clinical practice, in which many patients with diagnosed non-erosive GORD undergo repeated upper endoscopies, which might be both costly and ineffective.”

Australian gastroenterologist Professor Jon Watson, from University Hospital Geelong, said the study gave reassurance that patients with non-erosive GORD did not require regular endoscopic monitoring.

“The association between oesophagitis and oesophageal adenocarcinoma is well established, but most studies look at the risk of developing oesophageal adenocarcinoma among patients with erosive oesophagitis or Barrett’s oesophagus, a reflux-related condition where intestinal metaplasia develops in the oesophagus,” he told TMR.

“This study is therefore very helpful, as it has specifically looked at patients with non-erosive gastro-oesophageal reflux disease and shown that they are at similar risk of oesophageal adenocarcinoma as the corresponding general population.”

Previous studies had shown a low incidence of progression to oesophageal cancer in patients with non-erosive GORD, but this was the largest study of its kind, Professor Watson said.

He added there were other known risk factors for oesophageal cancer, such as obesity and tobacco smoking.

“These were not explicitly controlled for in this study in the comparison groups, so it is possible that this may have confounded the results to a certain extent.

“However, despite this potential confounding factor, this is an excellent study and is helpful in the management of oesophageal reflux disease.

In addition, Professor Watson noted the study found erosive GORD increased the risk of oesophageal cancer even in the absence of Barrett’s oesophagus.  

“It will be interesting to see if this changes practice, as this group of patients who have erosive GORD but no evidence of Barrett’s oesophagus, have not routinely been recommended for regular monitoring in previous guidelines.”

BMJ 2023, online 13 September

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