Heartburn, acid reflux and the discomfort experienced with gastro-oesophageal reflux disease (GORD) are well-known issues. Among individuals dealing with these symptoms, concerns about more serious conditions, such as oesophageal adenocarcinoma, can understandably arise.

Oesophageal adenocarcinoma is a type of cancer that originates in the oesophagus, the tube that carries food and liquids from the throat to the stomach. Adenocarcinoma, in this context, means that cancerous cells have developed in the glandular tissue of the oesophagus.

This type of cancer is often associated with long-term gastro-oesophageal reflux disease (GORD), where stomach acid frequently flows back into the oesophagus, causing irritation. Over time, this chronic irritation can lead to changes in the lining of the oesophagus, increasing the risk of oesophageal adenocarcinoma.

In cases of non-erosive GORD, individuals may still experience symptoms but without the visible signs of damage seen in erosive GORD.

A recent population-based cohort study published in The BMJ, a reputable weekly peer-reviewed medical journal, brings reassuring news to those with non-erosive GORD.

What the study revealed

The objective of this study was to assess the incidence rate of oesophageal adenocarcinoma among patients with non-erosive GORD when compared to the general population. Researchers combed through healthcare records in Denmark, Finland, and Sweden, spanning from 1 January 1987 to 31 December 2019.

The study included a substantial cohort of 486,556 adults, all of whom had undergone endoscopy. Of these, 285,811 patients fell into the non-erosive GORD cohort, while the remaining 200,745 were part of the validation cohort with erosive GORD. The key distinction between these two groups lies in the presence or absence of oesophagitis, a condition where the lining of the oesophagus becomes inflamed.

Among the 285,811 patients with non-erosive GORD, only 228 individuals developed oesophageal adenocarcinomas during 2,081,051 person-years of follow-up.

The incidence rate of oesophageal adenocarcinoma in patients with non-erosive GORD was 11.0 per 100,000 person-years.

Most notably, the incidence rate in this group was similar to that of the general population.

Further reassuring findings revealed that the risk of oesophageal adenocarcinoma did not increase with longer follow-up periods (15 to 31 years of follow-up).

Erosive reflux

Patients with erosive GORD at endoscopy sadly had a notable increased incidence of this tumour. By comparison, among patients with erosive esophagitis at baseline, the incidence of oesophageal cancer was more than double that in the general population, with increasing incidence over time.

  • Among the 200,745 patients with erosive oesophagitis at endoscopy, 542 developed oesophageal adenocarcinomas during 1,750,249 person-years of follow-up.
  • This group had a higher incidence rate of 31.0 per 100,000 person-years.
  • Importantly, the risk of oesophageal adenocarcinoma in this group increased with longer follow-up periods.
Gender differences

The study also uncovered interesting gender differences. Women were more likely to present with non-erosive GORD than men, which aligns with existing literature.

However, the finding that women retained a slightly increased incidence of developing oesophageal adenocarcinoma was less expected. While the increase was moderate and could be attributed to random error, it highlights the need for further research in this area.

Future impact

This study suggests that physicians do not need to consider referring patients with GORD and a previous normal upper endoscopy for repeat endoscopy unless they develop warning symptoms of oesophageal adenocarcinoma, mainly dysphagia, as recommended for all individuals.

This message contrasts with today’s clinical practice, in which many patients with diagnosed non-erosive GORD undergo repeated upper endoscopies, which might be both costly and ineffective.

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