Reflux disease not associated with increased cancer risk

Most people who have reflux disease do not have an increased risk of cancer, a new Swedish study has shown.

A team at the Karolinska Institutet, which led a large-scale study from three Nordic countries, found that cancer risk is elevated only in patients whose gastroscopy show changes in the oesophageal mucosa.

The findings are published in The BMJ.

First author Dr Dag Holmberg, researcher at the Department of Molecular Medicine and Surgery, Karolinska Institutet, said: “This is a gratifying result since reflux disease is a very common condition and most patients are found to have a completely normal mucus membrane on gastroscopic examination.

“Our study suggests that these repeated gastroscopies are probably unnecessary for people with reflux disease who have a normal oesophageal mucosa. These findings should be reassuring for this large patient group and can guide GPs who often treat them.”

The study is based on national health data registries in Sweden, Denmark and Finland, and included more than 285,000 individuals with reflux disease and no gastroscopic evidence of oesophagitis.

All patients were followed for up to 31 years and all cases of oesophageal cancer were registered. The cancer risk was then compared with that for those from the general population matched by age and sex over the same period in the three countries.

No increased risk of oesophageal cancer was observed in patients with reflux disease and a normal mucus membrane.

However, when they analysed the cancer risk in more than 200,000 individuals with reflux disease and oesophagitis, there was an increased relative risk of developing oesophageal cancer.

Last author Professor Jesper Lagergren, professor of surgery at the Department of Molecular Medicine and Surgery, Karolinska Institutet, said the team plans to examine what factors other than oesophagitis can be linked to tumour growth in people with reflux disease.

The study was a collaboration between researchers at Karolinska Institutet and Karolinska University Hospital, Sweden, the University of Copenhagen in Denmark, and the universities of Helsinki and Oulu in Finland.

Holmberg D, Santoni G, von Euler-Chelpin M et al. Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma: population-based cohort study in three Nordic countries. BMJ 15 September 2023; doi: 10.1136/bmj-2023-076017.

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