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Nonerosive GERD Might Not Be a Precursor of Esophageal Cancer
Patients with gastroesophageal reflux disease (GERD) often are referred for upper endoscopy to exclude erosive esophagitis and esophageal metaplasia (Barrett esophagus), both of which are known precursors of esophageal carcinoma. Most often, endoscopy reveals normal mucosa (nonerosive GERD), but risk for progression from this condition to premalignant or malignant lesions, and hence the need for repeat endoscopy, has been unclear.
Using comprehensive health databases from Denmark, Sweden, and Finland, researchers identified 485,000 patients who received diagnoses of GERD between 1987 and 2019 and underwent at least one upper endoscopy during this period. Of these patients, 59% had normal findings on their first endoscopy; the remainder had erosive esophagitis. Median follow-up was ≈7 years.
Among patients with nonerosive GERD at baseline, overall incidence of esophageal cancer was similar to that in the general population, with no upward trend during maximum follow-up of 31 years. In subgroup analyses, incidence of esophageal cancer was slightly higher in women with nonerosive GERD than in the general population (incidence ratio, 1.38), but the absolute incidence was much lower in women than in men. No other subgroup variations were noted. By comparison, among patients with erosive esophagitis at baseline, incidence of esophageal cancer was more than double that in the general population, with increasing incidence over time.
These results suggest that nonerosive GERD is not a risk factor for esophageal cancer, even after decades of follow-up. The authors propose that erosive esophagitis and nonerosive GERD represent two different phenotypes with distinct natural histories and that serial endoscopies are unnecessary for patients with nonerosive GERD on initial examination. The authors call for additional research to clarify the unexpected difference between men and women, and they speculate that “it might be explained by random error.”
Holmberg D et al.
Title: Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries: Population based cohort study.
Source: BMJ 2023 Sep 13; [e-pub]. (Abstract/FREE Full Text)