Endoscopy for gastroesophageal reflux disease and survival in esophageal adenocarcinoma

Abstract

Gastroesophageal reflux disease (GERD) is a risk factor of esophageal adenocarcinoma (EAC) and the most common indication for upper gastrointestinal endoscopy. Yet, whether GERD or endoscopy practice influence survival in EAC is largely unknown and was assessed in our study.This nationwide cohort study included all Swedish residents diagnosed with EAC in 1997-2013 with follow-up to 2018. Exposures were history of GERD and endoscopies prior to EAC. The main outcome was EAC-specific 5-year mortality. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for potential confounders. Among 6,600 EAC patients (79.3% males, median age 70 years) followed for 9,138 person-years, 440 (6.7%) had GERD and 592 (9.0%) had ≥1 endoscopy before EAC diagnosis. GERD was associated with a decreased risk of mortality (adjusted HR 0.71, 95% CI 0.64-0.80), which was only slightly attenuated by adjustment for prior endoscopies (HR 0.79, 95% CI 0.70-0.90), and further adjustments also for tumor stage and surgical resection (HR 0.74, 95% CI 0.62-0.89). Compared to EAC patients without prior endoscopy, mortality was unchanged in GERD patients having undergone 1 or 2 endoscopies before EAC diagnosis (HR 1.02, 95% CI 0.80-1.31, for 1 endoscopy; HR 0.90, 95% CI 0.63-1.30, for 2 endoscopies), while the mortality was decreased in patients with ≥3 endoscopies (HR 0.55, 95% CI 0.36-0.85). Our study indicates that GERD may be associated with a better prognosis in the event of EAC; however, the use of endoscopy screening has a limited impact on survival unless performed very frequently. Methods DesignThis nationwide, population-based cohort study included all patients in Sweden with a new diagnosis of EAC confirmed Additional Supporting Information may be found in the online version of this article.

Clinical and Lifestyle-Related Prognostic Indicators among Esophageal Adenocarcinoma Patients Receiving Treatment at a Comprehensive Cancer Center

“…However, associations between body mass index (BMI) and EAC survival are conflicting, with some reports suggesting positive relationships [ 18 , 19 , 22 ], and others no association [ 12 , 23 ]. Most studies have also indicated no survival associations with reflux [ 12 , 18 , 19 ], apart from a recent Scandinavian analysis reporting improved survival among symptomatic GERD patients [ 24 ]. A survival advantage was recently identified for physically active esophageal cancer patients [ 25 ], but was not reported in previous EAC-specific analyses [ 12 , 18 ].…”

Incidence and Mortality in Upper Gastrointestinal Cancer After Negative Endoscopy for Gastroesophageal Reflux Disease

“…27 Other studies have suggested that a negative endoscopy within a certain time frame before esophageal adenocarcinoma diagnosis improves survival. 28,29 However, none of these studies addressed whether upper endoscopy for upper gastrointestinal cancer is beneficial in patients with GERD.…”

Efficacy and safety of traditional Chinese herbal formula combined with western medicine for gastroesophageal reflux disease

“…[ 3 – 5 ] It reduces patients’ quality of life, and it is associated with a strong and severity-dependent increased risk of esophageal adenocarcinoma. [ 6 , 7 ]…”