Negative upper endoscopy findings in GERD signal lower upper gastrointestinal cancer risk

Negative upper endoscopy findings in patients with gastroesophageal reflux disease (GERD) indicate lower risk of developing upper gastrointestinal cancer, a new study has found.

Researchers conducted a population-based cohort study of 1,062,740 GERD patients (median age 58 years, 52 percent women) diagnosed between July 1, 1979 and December 31, 2018.

Over 3,036,104 person-years of follow-up during which no endoscopies were performed, 0.34 percent (n=3,601) of participants developed upper gastrointestinal cancer, of whom 2,856 died due to the malignancy. In comparison, among 736,759 patients with negative upper endoscopy findings, 1,609 (0.23 percent) developed upper gastrointestinal cancer over 4,429,751 person-years of follow-up, and 1,609 died.

Subsequent incidence analysis found that patients with negative findings show a 55-percent lower risk of developing upper gastrointestinal cancer (119 vs 38 per 100,000 person-years, adjusted hazard ratio [HR], 0.45, 95 percent confidence interval [CI], 0.43–0.48).

Such risk reduction remained significant when looking at either oesophageal (adjusted HR, 0.48, 95 percent CI, 0.44–0.51) and gastric (adjusted HR, 0.41, 95 percent CI, 0.38–0.45) cancer, and persisted when patients were stratified according to age and sex.

In turn, negative upper endoscopy findings likewise protected against mortality against upper gastrointestinal cancer, suppressing such risk by over 60 percent (94 vs 36 per 100,000 person-years; adjusted HR, 0.39, 95 percent CI, 0.37–0.42).

“To our knowledge, this is the largest study to date assessing the role of upper endoscopy for GERD in relation to the incidence and mortality of upper gastrointestinal cancer. It is also the first study examining the durability of these risk reductions,” the researchers said.