Antacid Drug Use and Risk of Esophageal and Gastric Adenocarcinomas in Los Angeles County

Abstract

Objectives: Concern has been expressed that antacid drugs increase the risk of esophageal and gastric adenocarcinomas.Methods: This population-based case-control study recruited patients with incident esophageal adenocarcinoma (n = 220), gastric cardiac adenocarcinoma (n = 277), or distal gastric adenocarcinoma (n = 441) diagnosed between 1992 and 1997, and 1,356 control participants in Los Angeles County. Unconditional polychotomous multivariable logistic regression analyses were done to evaluate the association between antacid drug use and these cancers. Results: Among participants who took nonprescription acid neutralizing agents for >3 years, the odds ratio for esophageal adenocarcinoma was 6.32 compared with never users (95% confidence interval, 3.14-12.69; P trend < 0.01). Analyses stratified by history of physician diagnosed upper gastrointestinal (UGI) disorders revealed a greater increase in esophageal adenocarcinoma risk associated with nonprescription antacid use among persons with no UGI disorder than among those with an UGI disorder (homogeneity of trends P = 0.07). Regular use of nonprescription acid neutralizing agents was not associated with risk of adenocarcinomas of the gastric cardia or distal stomach. Regular use of prescription acid suppressive drugs was not associated with risk for any of these cancers. Conclusion: We found risk of esophageal adenocarcinoma was greater among long-term nonprescription acid neutralizing drugs in participants without physician-diagnosed UGI conditions than among those with these conditions; this may represent self medication for undiagnosed precursor conditions or it may be that nonprescription acid neutralizing drugs, taken without limitation on amount used when symptoms are most intense, may permit alkaline bile reflux into the lower esophagus, thereby increasing esophageal adenocarcinoma risk. (Cancer Epidemiol Biomarkers Prev 2009;18(2):526 -33)

Gastroesophageal Reflux Disease Symptom Severity, Proton Pump Inhibitor Use, and Esophageal Carcinogenesis

“…Those studies attributed this finding to confounding by intent, whereby PPI use was simply a marker for the severity of the patient's GERD rather than a direct causative factor. 39,48,49 Finally, consistent with the published literature, our results demonstrated a positive correlation between symptom severity and the presence of esophagitis. 24,50,51 …”

Diabetes and risk of esophageal and gastric adenocarcinomas

“…Characteristics of the study participants have been described in details previously 25, 32 . Diabetes was diagnosed in 9% of control participants and 13% of case patients.…”

“…The details of the study population and design have been described previously 24–32 . Briefly, cases for this study were men and women, ages 30–74 years with histologically confirmed, incident esophageal adenocarcinoma (EA; International Classification of Disease for Oncology code C15.0–C15.9), gastric cardiac adenocarcinoma (GCA; International Classification of Disease for Oncology code C16.0), or distal gastric adenocarcinoma (DGA; International Classification of Disease for Oncology codes C16.1–C16.6 and C16.8–C16.9) diagnosed between 1992 and 1997.…”

“…The details of the study population and design have been described previously. [24][25][26][27][28][29][30][31][32] Briefly, cases for our study were They were individually matched to each case patient on sex, race, age (65 years) and neighborhood of residence. A systematic algorithm based on the address of the case patient was used to recruit control subjects.…”

Reliability of Family Proxy Data for Studies of Malignant Mesothelioma: Results from the ATSDR Pilot Surveillance

“…The ability to interview persons with newly diagnosed MM is limited because of the very short survival period. Proxy interviewing is a commonly used method of obtaining information on persons with rapidly fatal diseases [8, 9]. However, some studies have shown that data received from proxies may be inaccurate or require the review of additional information sources [10–12].…”