Rebutting conventional wisdom, a large Swedish study finds that most people with chronic acid reflux, or GERD, do not have a higher risk for developing cancer of the esophagus.
“Previous studies have shown that individuals with repeated symptoms of acid reflux – [such as] heartburn and/or regurgitation -- have a propensity to develop esophageal cancer,” said lead researcher Dr. Dag Holmberg, a postdoctoral researcher at the Karolinska Institute in Stockholm.
“We found that these individuals had the same risk of cancer as the general population,” he said, adding "the results were clear virtually across the board. There was no association.”
Chronic acid reflux — also known as GERD (gastroesophageal reflux disease) — has long been thought to drive up cancer risk, because of its potential to injure the lining of the esophagus, the long tube that carries food and drink from the throat to the stomach, Holmberg explained.
Over time, this process — known as esopaghitis — causes tissue in the tube to become more acid-resistant. When that happens, he noted, prior research has demonstrated “a clearly increased risk of developing esophageal cancer.”
But, Holmberg said, the majority of patients with acid reflux have a normal esophageal lining without any signs of injury. He and his team wanted to see if the long-standing presumption that GERD patients have an increased cancer risk might be misplaced.
To learn more, investigators analyzed national health registry information for two groups of patients across Sweden, Denmark and Finland.
Patients in both groups had been treated for reflux disease between 1987 and 2019, either in a hospital or an outpatient setting.
The first group included more than 285,000 men and women with reflux disease but no evidence of esophagitis when examined with a scope.
The second group included roughly 200,000 patients with evidence of esophageal injury.
Both groups were tracked for up to 31 years. Esophageal cancer cases were compared to rates in the general population over the same period.
Among the GERD-with-injury group, researchers did find an increased risk for esophageal cancer.
But they found no overall indication of an increased risk among GERD patients with no esophageal injury, except for a "very moderate" uptick in women's risk.
“Clinically, I do not think it has much bearing,” Holmberg said. "The risk of esophageal cancer in women is extremely low, and about 85% of all tumors develop in men. And because the risk increase was very moderate, it does not merit for further monitoring.”
The reassuring takeaway?
"Patients with acid reflux and with a normal upper endoscopy do not need to worry about esophageal cancer in the future,” he said. “Their risk is not elevated.”
The findings were published Sept. 13 in BMJ.
All of which could prove to be very welcome news for the majority of GERD patients who don’t experience esophageal injury, said Connie Diekman, a St. Louis-based food and nutrition consultant and former president of the Academy of Nutrition and Dietetics.
“I have treated many people with GERD,” said Diekman, adding that the goal has always been to prevent damage to the esophagus given that reflux disease has long been viewed as a potential risk for cancer.
If the Swedish study proves to be accurate, Diekman said, it would mean that once an initial endoscopic evaluation confirms that a GERD patient’s esophagus has no signs of damage, routine endoscopies after that may not be needed.
“This obviously would be a cost saver, and a relief to patients,” she said.
Diekman said patients should discuss their risks with their doctors and then use that information to make the best decisions for their health care.