41P Increased lung cancer risk in gastroesophageal reflux disease and Helicobacter pylori infection patients: Systematic review and meta-analysis

Abstract

Background: Gastroesophageal reflux disease (GERD) and Helicobacter pylori infection are globally prevalent diseases. Recent studies suggested that GERD is associated with increased lung cancer risk although the results were still inconclusive. Previous studies also suggested that lung cancer is an extra-gastric manifestation of H. pylori infection although the results were inconsistent. This study aims to measure the lung cancer risk in the GERD and H. pylori infection patients. Methods: We did comprehensive searching in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies from January 2000 until January 2021. We included all observational studies particularly cohort studies, that access the lung cancer risk in GERD and H. pylori infection patients. Bias risk was accessed with The Newcastle-Ottawa Scale for observational studies. Analysis was performed to provide pooled risk ratios (RR) with 95% confidence interval (CI) using random-effect heterogeneity test. Results: We included 5 cohort and 4 cross-sectional studies met our inclusion criteria. Analysis of 3 GERD cohort studies suggests that GERD increase lung cancer risk significantly (pooled RR = 1.47, 95% CI 1.13-1.91, p = 0.004, I 2 = 70%). Significant incremental lung cancer risk in H. pylori infection was shown in both cohort ( pooled RR = 1.55, 95% CI 1.10-2.18, p = 0.01, I 2 = 39%) and non-cohort (pooled RR = 2.06, 95% CI 1.22-3.46, p = 0.006, I 2 = 62%) studies analysis, thus the overall analysis also suggests significantly increased lung cancer risk in H. pylori infection patients (pooled RR = 1.74, 95% CI 1.30-2.33, p = 0.0002, I 2 = 50%). Conclusions: Gastroesophageal reflux disease and Helicobacter pylori infection increase lung cancer risks. However, further studies are needed to establish the causalities.Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Causal associations between gastroesophageal reflux disease and lung cancer risk: A Mendelian randomization study

“… 12 Furthermore, GERD has a significant association with lung cancer according to a meta‐analysis that pools three GERD cohorts (pooled RR = 1.47; 95% CI 1.13–1.91). 13 Overall, these results from observational studies collectively indicate lung cancer risk may be increased by GERD.…”

“…Besides, a population‐based cohort conducted in Taiwan, which include 42,555 individuals, also reveal that GERD patients have a considerably greater prevalence of lung cancer than healthy controls [hazard ratio (RR) = 1.53; 95% CI 1.19–1.98] 12 . Furthermore, GERD has a significant association with lung cancer according to a meta‐analysis that pools three GERD cohorts (pooled RR = 1.47; 95% CI 1.13–1.91) 13 . Overall, these results from observational studies collectively indicate lung cancer risk may be increased by GERD.…”

“… 11 Meanwhile, GERD has been associated with an increased risk of lung cancer in previous studies. 12 , 13 , 14 , 15 …”

“…Furthermore, growing evidence showing that gastroduodenal contents may have an impact on adjacent organs proximal to the esophagus as well as distant systems, especially considering that they lack the similar natural protective systems as the esophagus 11 . Meanwhile, GERD has been associated with an increased risk of lung cancer in previous studies 12–15 …”

“… 9 , 10 , 11 In addition, several observational studies also add evidence that GERD might increase the risk of lung cancer. 12 , 13 , 14 , 15 Whereas, given the absence of clear evidence from randomized controlled trials (RCTs) between GERD and lung cancer, there is no clear evidence that GERD poses a causal link to lung cancer.…”