Heartburn or gastroesophageal reflux disease (GERD) is a widespread health problem affecting 10 to 20% of adults in western populations. If GERD is left untreated, it could increase the risk of developing Esophageal cancer (adenocarcinoma type).
GERD is typically treated with different types of medications, such as antacids, that neutralize stomach acids and others that reduce or block acid production. Another option is to have antireflux surgery which prevents the stomach contents from coming up into the esophagus, but it was uncertain whether it could be a better alternative to prevent esophageal adenocarcinoma due to the lack of conclusive studies with large sample size and long-term follow up.
A recent study from Karolinska Institutet, which included 942,906 patients from the 5 Nordic countries and health data from the year 1964 to 2014, revealed that both antireflux surgery and medication could prevent esophageal adenocarcinoma.
Out of the total number of patients, about 48,414 patients had antireflux surgery of which 177 (0.4%) new cases of esophageal adenocarcinoma were identified during follow up. The risk of oesophageal cancer was high after surgery, but it decreased over time till it reached the same level as in the corresponding population 15 years or more after the operation.
The rest of the patients, about 894,492 individuals, were treated with medication, 2368 (0.3%) of which developed esophageal adenocarcinoma. The risk of oesophageal adenocarcinoma also decreased over time in this group.
A slightly higher risk of esophageal adenocarcinoma was observed in patients who underwent antireflux surgery compared with patients who were only treated with medication which can be explained by the higher severity and longer duration of GERD in patients selected for the operation which increased their risk of developing esophageal adenocarcinoma.
"The results show that effective medical or surgical treatment of reflux prevents cancer of the esophagus. But because the individual's risk of developing oesophageal cancer is low, even in those with reflux disease, the results do not justify treating reflux solely as a cancer-preventive measure. The symptoms and complications of reflux disease should continue to govern treatment," says John Maret-Ouda, physician and scientist at the Department of Molecular Medicine and Surgery at Karolinska Institutet in Sweden and the first author of the study.
However, he recommends continuous medical treatment or surgery for patients who suffer from severe GERD in addition to other risk factors for esophageal adenocarcinoma as obesity, male gender and old age.
"Previous research results have shown poor cancer-preventive effects from anti-reflux surgery. The difference now is that for the first time we can show statistically significant results because we have a sufficiently large study with a long follow-up period of over 15 years following the operation," says Jesper Lagergren, consultant surgeon and professor at the Department of Molecular Medicine and Surgery, Karolinska Institutet, who led the study.