Non-erosive gastro-oesophageal reflux disease not associated with increased incidence of oesophageal adenocarcinoma

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1. Patients with non-erosive gastro-esophageal reflux disease (GERD) do not have an increased incidence of developing esophageal adenocarcinoma compared to the general population.

Evidence Rating Level: 2 (Good)

For patients with gastro-esophageal reflux disease (GERD), endoscopic findings of mucosal erosion or metaplasia are associated with increased risk of esophageal adenocarcinoma. However, there has been no study to determine whether patients with non-erosive GERD, meaning normal endoscopic mucosal findings, are at increased risk for this type of malignancy. Therefore, this population based study based in Denmark, Finland, and Sweden aimed to compare the incidence of esophageal adenocarcinoma between patients with non-erosive GERD and the general population. The non-erosive GERD patients consisted of individuals with at least 1 endoscopy done between 1987 to 2019, with no baseline diagnosis of esophageal cancer, gastric cancer, or Barrett esophagus. Patients were excluded if they had an endoscopy prior to the study period, before the age of 18, or after the age of 90. A cohort of erosive GERD patients were also analyzed for validation purposes. Additionally, standardized incidence ratios were calculated using the general population incidence. In total, there were 285,811 non-erosive GERD patients, with a follow-up of 2,081,051 person-years (median 6.3 years). There were 200,745 erosive GERD patients analyzed. The results showed that 0.08% of non-erosive GERD patients developed esophageal adenocarcinoma, with an incidence of 11.0 per 100,000 person-years, and a standardized incidence ratio of 1.04 (95% CI 0.91-1.18). In comparison, the erosive GERD cohort had a prevalence of 0.27% developing cancer, with an incidence of 31.0 per 100,000 person-years, and a standardized incidence ratio of 2.36 (95% CI 2.17-2.57). Overall, this study demonstrated that the incidence of esophageal adenocarcinoma in non-erosive GERD patients is similar to that of the general population.

Click to read the study in BMJ

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