Original article—alimentary tractErosive Reflux Disease Increases Risk for Esophageal Adenocarcinoma, Compared With Nonerosive Reflux
Section snippets
Methods
This nationwide cohort study used population-based medical registries from Denmark (5.4 million inhabitants). The Danish National Health Service provides tax-funded medical care for all Danish residents. We used the unique personal identifier assigned to each Danish citizen at birth to electronically link individuals between databases.11 The study was approved by the Danish Data Protection Agency.
Results
From 1996 to 2008 we identified 33,849 patients with reflux disease who underwent EGD within 1 month of their diagnosis. The median age was 59.3 years and 52% were men. The majority of patients were diagnosed with erosive disease (n = 26,194), and those patients were older than those in the nonerosive group (median age, 59.8 vs 58.0 y; P < .001) and more likely to be men (54% vs 43%; P < .001) (Table 1). Patients with erosive reflux disease were followed up longer than those with nonerosive
Discussion
In our large population-based cohort study we found that only erosive disease was associated with an increased risk of adenocarcinoma of the esophagus; 10 years after the diagnosis 0.24% had developed adenocarcinoma. Our findings suggest that endoscopically evident mucosal damage is important in the progression from normal mucosa to cancer and that Barrett's esophagus is likely to be an intermediate step.
Our results extend experimental evidence into clinical pathology. Esophageal adenocarcinoma
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Etiology, cancer stem cells and potential diagnostic biomarkers for esophageal cancer
2019, Cancer LettersCitation Excerpt :These alternations may have some influence in the progression of ESCC [33]. Barrett's esophagus (BE) is the only known risk factor of EAC, and BE develops following chronic and erosive reflux [34,35]. EAC pathogenesis has also been associated with decreased estrogen exposure [36], single-nucleotide polymorphisms in cancer-related genes [37] and obesity [38].
The Male Predominance in Esophageal Adenocarcinoma
2016, Clinical Gastroenterology and HepatologyCitation Excerpt :Rather, a recent pooled analysis of 5 case-control studies revealed slightly higher risk estimates associated with reflux in women than in men.29 However, reflux disease is seemingly more severe in men than in women.30–32 Erosive reflux disease has been shown to be a stronger risk factor for EAC than nonerosive reflux disease.
Predictors of Progression to High-Grade Dysplasia or Adenocarcinoma in Barrett's Esophagus
2015, Gastroenterology Clinics of North AmericaCitation Excerpt :A Dutch multicenter cohort study found an increased risk of progression to adenocarcinoma or high-grade dysplasia in patients with Barrett’s esophagus with esophagitis at baseline endoscopy (risk ratio [RR], 3.5; 95% CI, 1.3–9.5).12 A Danish cohort study also found an increased standardized incidence ratio for esophageal adenocarcinoma among patients with Barrett’s esophagus with erosive esophagitis when compared with the general population (standardized incidence ratio, 5.2; 95% CI, 4.6–5.8).18 Ulceration within a Barrett’s segment is also associated with an increased risk of neoplastic progression to adenocarcinoma or high-grade dysplasia.
Conflicts of interest The authors disclose no conflicts.
The Department of Clinical Epidemiology, Aarhus University Hospital, receives funding for other studies from companies in the form of research grants to (and administered by) Aarhus University. None of these studies have any relation to the present study.
Funding This research was supported by the Clinical Epidemiology Research Foundation, Aarhus University Hospital, Denmark, and the Karen Elise Jensen foundation.