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NON-EROSIVE GASTROESOPHAGEAL REFLUX DISEASE AND RISK OF ESOPHAGEAL ADENOCARCINOMA

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Introduction

Gastroesophageal reflux disease (GERD) is associated with an increased risk of esophageal adenocarcinoma, but whether patients with non-erosive GERD, i.e., GERD symptoms without esophageal mucosal abnormalities, are at an increased risk is unknown.

Aims & Methods

This population-based cohort study included all 486,556 patients who underwent endoscopy for GERD in Finland, Denmark, or Sweden from 1987-2019. Non-erosive GERD was defined by an absence of esophagitis and any other esophageal diagnosis within 12 months of the endoscopy, while erosive GERD was defined by the presence of esophagitis at endoscopy. Standardized incidence ratios (SIR) with 95% confidence intervals (95%CI) were calculated by dividing the observed number of esophageal adenocarcinomas in the non-erosive and erosive GERD cohorts, analyzed separately, by the expected number, derived from the general populations in Finland, Denmark, and Sweden of the corresponding age, sex, and calendar period.

Results

Among 285,811 patients with non-erosive GERD, 228 developed esophageal adenocarcinomas during 2,081,051 person-years of follow-up. The overall risk of esophageal adenocarcinoma was similar to that of the background population (SIR 1.04, 95%CI 0.91-1.18), and did not increase with longer follow-up. Patients with erosive esophagitis at endoscopy (200,745 patients, 1,750,249 person-years, and 542 esophageal adenocarcinomas) had a notable increased overall risk of esophageal adenocarcinoma (SIR 2.36, 95%CI 2.17-2.57), which became more pronounced with longer follow-up.

Conclusion

Patients with non-erosive GERD seem to have a similar risk of esophageal adenocarcinoma compared to the corresponding background population. This finding is relieving for the majority of GERD patients with normal endoscopy and may guide follow-up strategies.