Clinical Question

Are patients with nonerosive gastroesophageal reflux disease (GERD) at an increased risk of esophageal cancer compared with the average population?

Bottom Line

Nonerosive GERD does not increase the likelihood of esophageal cancer. However, erosive GERD is associated with a doubled, but still low, risk of developing cancer, with the likelihood increasing over time. (Level of Evidence = 1b)

Synopsis

The Scandinavian researchers followed up on 486,556 adults who underwent endoscopy in Denmark, Finland, and Sweden. These countries have national registries, which allows follow-up of patients over time; the study took place over a 32-year period that ended in 2019. Among the 285,811 patients with nonerosive GERD, 228 (0.08%) developed esophageal cancer during 2,081,051 person-years of follow-up (median follow-up was 6.3 years, although some patients were followed for up to 31 years). This rate is similar to the rate of developing esophageal cancer in the general population. In contrast, 542 patients (0.27%) with erosive GERD subsequently developed cancer. These results may not apply to Eastern Asia, where the overall incidence of esophageal cancer is higher than other countries.

Study design: Cohort (prospective)

Funding source: Foundation

Setting: Population-based

Reference: Holmberg D, Santoni G, von Euler-Chelpin M, et al. Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries: population based cohort study. BMJ. 2023;382:e076017.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.