Gastroesophageal reflux disease, use of H-2 receptor antagonists, and riskof esophageal and gastric cancer

Objective: The incidence of esophageal adenocarcinoma has risen rapidly in the past two decades, for unknown reasons. The goal of this analysis was to determine whether gastroesophageal reflux disease (GERD) or the medication s used to treat it are associated with an increased risk of esophageal or g astric cancer, using data from a large population-based case-control study. Methods: Cases were aged 30-79 years, newly diagnosed with esophageal adeno carcinoma (n = 293), esophageal squamous cell carcinoma (n = 221), gastric cardia adenocarcinoma (n = 261), or non-cardia gastric adenocarcinoma (n = 368) in three areas with population-based tumor registries. Controls (n = 6 95) were chosen by random digit dialing and from Health Care Financing Admi nistration rosters. Data were collected using an in-person structured inter view. Results: History of gastric ulcer was associated with an increased risk of non-cardia gastric adenocarcinoma (OR 2.1, 95% CI 1.4-3.2). Risk of esophag eal adenocarcinoma increased with frequency of GERD symptoms; the odds rati o in those reporting daily symptoms was 5.5 (95% CI 3.2-9.3). Ever having u sed H-2 blockers was unassociated with esophageal adenocarcinoma risk (OR 0 .9, 95% CI 0.5-1.5). The odds ratio was 1.3 (95% CI 0.6-2.8) in long-term ( 4 or more years) users, but increased to 2.1 (95% CI 0.8-5.6) when use in t he 5 years prior to the interview was disregarded. Risk was also modestly i ncreased among users of antacids. Neither GERD symptoms nor use of H-2 bloc kers or antacids was associated with risk of the other three tumor types. Conclusions: Individuals with long-standing GERD are at increased risk of e sophageal adenocarcinoma, whether or not the symptoms are treated with H-2 blockers or antacids.