Gastroesophageal Reflux in Relation to Adenocarcinomas of the Esophagus: A Pooled Analysis from the Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON)

Abstract

BackgroundPrevious studies have evidenced an association between gastroesophageal reflux and esophageal adenocarcinoma (EA). It is unknown to what extent these associations vary by population, age, sex, body mass index, and cigarette smoking, or whether duration and frequency of symptoms interact in predicting risk. The Barrett’s and Esophageal Adenocarcinoma Consortium (BEACON) allowed an in-depth assessment of these issues.MethodsDetailed information on heartburn and regurgitation symptoms and covariates were available from five BEACON case-control studies of EA and esophagogastric junction adenocarcinoma (EGJA). We conducted single-study multivariable logistic regressions followed by random-effects meta-analysis. Stratified analyses, meta-regressions, and sensitivity analyses were also conducted.ResultsFive studies provided 1,128 EA cases, 1,229 EGJA cases, and 4,057 controls for analysis. All summary estimates indicated positive, significant associations between heartburn/regurgitation symptoms and EA. Increasing heartburn duration was associated with increasing EA risk; odds ratios were 2.80, 3.85, and 6.24 for symptom durations of <10 years, 10 to <20 years, and ≥20 years. Associations with EGJA were slighter weaker, but still statistically significant for those with the highest exposure. Both frequency and duration of heartburn/regurgitation symptoms were independently associated with higher risk. We observed similar strengths of associations when stratified by age, sex, cigarette smoking, and body mass index.ConclusionsThis analysis indicates that the association between heartburn/regurgitation symptoms and EA is strong, increases with increased duration and/or frequency, and is consistent across major risk factors. Weaker associations for EGJA suggest that this cancer site has a dissimilar pathogenesis or represents a mixed population of patients.

Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy

“…Short-term data suggest that POEM is as effective as LHM in treating dysphagia with similar rates of postoperative reflux although randomized controlled trials have yet to be performed [17][18][19]. In cohort studies, postoperative reflux is reported in 0-53 % of patients following POEM [6][7][8][20][21][22]. Some of this variability may relate to differences in subjective and objective measurements of acid reflux.…”

“…In contrast to Heller myotomy, no anti-reflux procedure is included and the rate of postoperative reflux has varied widely from 0 to 53 % in published studies [2][3][4]. This variation has created debate as to whether all patients should be treated with acid suppression postoperatively to avoid the complications of uncontrolled reflux such as erosive esophagitis, peptic stricture, and Barrett's esophagus [5][6][7].An alternative to lifelong treatment with proton pump inhibitors (PPI) is tailored PPI use based on the presence of …”

Nutritional Management of Esophageal Cancer Patients

“…Moreover, obesity, especially central type, and gastroesophageal reflux disease are risk factors toward developing esophageal adenocarcinoma [5,6]. On the other hand, healthy dietary habits could be a shield against some types of esophageal cancer [7], while nutritional support could be beneficial for the management of these patients after cancer diagnosis.…”

The Rationale and Efficacy of Primary and Secondary Prevention in Adenocarcinomas of the Upper Gastrointestinal Tract

“…49-5.25) in the presence of reflux symptoms, of 5.85 (95% CI 3.18-10.75) in case of a hiatus hernia and of 8.11 (95% CI 4.75-13.87) in case of both factors being present [10]. There is a clear need for non-invasive tools for identifying patients at risk who do not present with typical symptoms [5,11]. Blood-based markers would be most feasible regarding clinical applicability.…”