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GERD and Esophageal Cancer Link Becomes Clearer

Link between GERD and esophageal cancer becomes clearer

The incidence of esophageal cancer has been increasing dramatically, and while experts have long known GERD (gastroesophageal reflux disease) is a risk factor, the link between the two is now clearer. The clarity comes via the work of a research team at Aarhus University Hospital.

GERD is a risk factor for esophageal cancer

The risk factors for esophageal cancer are largely preventable ones, as they pertain to lifestyle. One of those risk factors is GERD, which also is on the rise. Chronic gastric reflux occurs when stomach acid and/or bile flows back into the esophagus on a regular basis, causing irritation and inflammation of the lining of the esophagus.

The specific role of inflammation associated GERD as a risk factor for esophageal cancer has not been entirely clear. According to Rune Erichsen, MD, of Aarhus University Hospital, and his team, their research shows that “damage to the esophageal lining that can be seen with endoscopy is important in the progression from normal cells to cancer, and Barrett’s esophagus is likely to be an intermediate step.”

Barrett’s esophagus is a complication of GERD and a condition in which the normal tissue lining the esophagus transforms into tissue that resembles the lining of the intestine. About 10% to 15% of people with chronic symptoms of GERD develop Barrett’s esophagus, and about 1% of people with Barrett’s esophagus go on to develop esophageal cancer.

In the new study, data from 33,849 individuals with reflux disease were evaluated. Seventy-seven percent (26,194) of the patients had GERD (erosive reflux disease), and 37 developed esophageal cancer after an average follow-up of 7.4 years, which is a higher incidence than seen in the general population. Of the 7,655 patients with nonerosive reflux disease, however, only one was diagnosed with esophageal cancer after an average of 4.5 years of follow-up.

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Other risk factors for esophageal cancer
Esophageal cancer can develop as one of two forms: squamous cell carcinoma, which begins in flat cells that line the esophagus; and adenocarcinoma, which starts in cells that make and release mucus and other fluids. The National Cancer Institute has estimated there will be 17,460 new cases of esophageal cancer in 2012, with 15,070 deaths.

Besides GERD, other risk factors for esophageal cancer include

  • Diet: A diet heavy on fat and red meat and light on fruits and vegetables is a risk factor
  • Hot liquids: Drinking hot tea from a very young age is a common practice in China, where the incidence of esophageal cancer is about ten times that in the United States. Consuming hot drinks is believed to be a significant factor.
  • Obesity: A recent study found that abdominal obesity may be related to an increased risk of esophageal cancer. Abdominal obesity is more common among men, who are also three times more likely than women to develop the disease.
  • Alcohol consumption: Drinking a lot of alcohol, especially hard liquor, increases one’s risk for the disease
  • Smoking: This is a significant risk factor for esophageal cancer.
  • Autoimmune disease: A recent study by the National Cancer Institute found that a history of autoimmune diseases such as celiac disease, reactive arthritis, and systemic sclerosis were associated with a significantly increased risk of esophageal cancer.

To help prevent development of esophageal cancer, individuals can take steps to avoid most of the risk factors mentioned. In addition, anyone who experiences symptoms of esophageal cancer should see their physician. Early esophageal cancer may not cause symptoms, but when they appear they can include painful swallowing, food getting stuck in the esophagus or coming back up, pain in the chest or back, hoarseness or cough lasting more than two weeks, and heartburn.

The results of this latest study indicate that inflammation of the esophagus plays a significant role in esophageal cancer. However, Erichsen noted that “Although reflux patients with a history of inflammation, irritation or swelling of the esophagus are at increased risk for esophageal cancer, the absolute risk of cancer even in these patients is very low.”

Erichsen R et al. Erosive reflux disease increases risk for esophageal adenocarcinoma compared with nonerosive reflux. Clin Gastroenterol Hepatol 2012 May; 10(5): 475-80
Landgren AM et al. Autoimmune disease and subsequent risk of developing alimentary tract cancers among 4.5 million US male veterans. Cancer 2011 Mar 15; 117(6): 1163-71
National Cancer Institute

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