GERD tied to upper respiratory cancers in older adults

Last Updated: 2017-12-26

By Marilynn Larkin

NEW YORK (Reuters Health) - Gastroesophageal reflux disease (GERD) is associated with malignancy of the upper aerodigestive tract (UADT) in U.S. adults ages 66 and older, researchers suggest.

Dr. Edward McCoul of the Ochsner Clinic Foundation in New Orleans and colleagues used the SEER-Medicare database to examine the association between GERD and cancers of the larynx, hypopharynx, oropharynx, tonsil, nasopharynx and paranasal sinuses between 2003 to 2011.

They compared 13,805 patients with a UADT malignancy (median age 74, 25% women) to 13,805 patients without cancer, matched for sex, age and year of diagnosis.

As reported in JAMA Otolaryngology-Head and Neck Surgery, online December 21, GERD was associated with significantly greater odds of developing malignancy of the larynx (adjusted odds ratio 2.86), hypopharynx (aOR, 2.54), oropharynx (aOR, 2.47), tonsil (aOR, 2.14), nasopharynx (aOR, 2.04), and paranasal sinuses (aOR, 1.40).

A significant association between GERD and UADT malignancies remained even when GERD exposure time was taken into account.

A survival analysis showed patient survival remains similar regardless of exposure lead times, and those with hypopharynx or oropharynx malignancies had worse survival rates than those with other UADT cancer types.

A secondary case-cohort analysis examined the prevalence of UADT cancers across the nonexposed and exposed populations. Laryngeal cancer was diagnosed in 0.72% of patients with GERD compared with 0.21% of those without GERD - a relative risk of 3.47.

"It is important to point out that a causative link cannot be established from this type of data," Dr. McCoul cautioned in an email. "It is unclear what effect acid exposure may have on tumor development, although chronic inflammation is a possibility."

"Further research should focus on assessing these associations in a younger population and investigating mechanisms of causation," he said.

Like Dr. McCoul, Dr. Joseph Curry of Thomas Jefferson University in Philadelphia, stressed that the epidemiological study "doesn't prove that cancer is caused by reflux."

"More work would be required to investigate what that relationship is," he said by email.

"One interesting finding is that the relationship between reflux and cancer appears to be stronger for cancers located closer to the esophagus - and to the acid reflux," he added.

What should patients be told?

"I would say that the study shows an association between head and neck cancers and reflux in older patients," Dr. Curry said. "We know that GERD plays a role in causing esophageal cancer, so it is an important and potentially serious problem that requires treatment."

SOURCE: http://bit.ly/2zxXhUa

JAMA Otolaryngol Head Neck Surg 2017.