GERD Surgery May Not Prevent Esophageal Cancer
Patients who have surgery to treat severe gastroesophageal reflux disease, also known as GERD, continue to have a high risk of developing cancer of the esophagus, according to a new study from the Karolinsa Institute in Stockholm. Esophageal cancers is one of the most ten common cancers in the United States.
GERD is a known risk factor for esophageal cancer. Acid from the stomach refluxes back up into the esophagus, causing heart burn and inflammation to the lining of the esophagus – a condition known as Barrett’s esophagus. While Barrett’s esophagus itself is not cancerous, it causes damage to the cells which can lead to cancer. It occurs in approximately 10% of patients with GERD.
Dr. Jesper Lagergren and colleagues studied over 14,000 Swedish patients who had anti-reflux surgery between the years 1965 and 2006. The most common surgical procedure for treating GERD is the Nissen fundoplication, which reinforces the lower esophageal sphincter between the esophagus and the stomach to prevent the reflux of stomach acid into the esophagus. The overall risk of developing esophageal cancer was 12 times that of the general Swedish population, and the risk did not decrease with time after the surgery, even up to 15 years.
Dr. Lagergren, professor of surgery at the Karolinska Institute in Stockholm, said, "We expected a decreased risk of cancer with increased time after surgery, but we didn't find it. There is no evidence to support the idea that anti-reflux surgery prevents cancer development of the esophagus." The professor believes that the length of time patients had reflux prior to surgery and the severity of the illness contributed to the lack of decrease in cancer risk.
The American Institute for Cancer Research has found that cancer of the esophagus is one of the most preventable cancers in both men and women, with obesity, smoking, and alcohol being some of the greatest risk factors. About 16,740 new cases were diagnosed in the US in 2009.
Lifestyle changes that can treat GERD before damage occurs that leads to cancer include weight loss, smoking and alcohol cessation, and medical treatment of the symptoms of heartburn with antacids (Tums, Rolaids, Mylanta are examples), foaming agents such as Gaviscon, H2 blockers including Tagamet and Pepcid, or Proton-Pump Inhibitors (PPI) such as Prilosec, Protonix, Nexium and Aciphex.