title: Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) is a proposed risk factor for developing laryngeal and pharyngeal cancers. No controlled study has examined this association.
  
  
  METHODS
  A case-control-study was performed using the computerized hospitalization and outpatient databases of the US Department of Veterans Affairs. All patients, who were veterans, had been identified as being hospitalized with laryngeal or pharyngeal during 1991 to 1997. In addition, all persons diagnosed with laryngeal or pharyngeal cancer in 1999 in the outpatient files were identified. From the same patient populations, four nonmatched control subjects were randomly assigned for each case. The medical history for cases and controls was retrospectively searched for GERD diagnoses, tobacco use, and alcohol dependence. Multivariable logistic regression analyses were performed to assess the risk factors for laryngeal and pharyngeal cancers.
  
  
  RESULTS
  A total of 8,228 hospitalized patients with laryngeal cancers and 1,912 with pharyngeal cancers were compared to 32,912 and 7,648 hospitalized controls, while 9,292 outpatients with laryngeal cancer and 2,769 outpatients with pharyngeal cancer were compared with 37,168 and 11,076 outpatient controls without cancer. Among hospitalized persons, the prevalence of GERD was higher among patients with laryngeal cancer (8.9 vs 4.0%, p < 0.0001) and pharyngeal cancer (6.2 vs 3.8%, p < 0.0001). In a multivariable logistic regression analysis that was controlled for age, gender, ethnicity, smoking, and alcohol, GERD was associated with an adjusted odds ratio (OR) of 2.40 for laryngeal cancer among hospitalized patients (95% CI 2.15-2.69, p < 0.0001) and an adjusted OR of 2.38 (95% CI 1.87-3.02, p < 0.0001) for pharyngeal cancer. For outpatients, GERD was associated with an adjusted OR = 2.31 (95% CI 2.10-2.53) for laryngeal cancer and adjusted OR = 1.92 (95% CI 1.72-2.15).
  
  
  CONCLUSIONS
  Among US veterans, the risk for laryngeal or pharyngeal cancers is modestly increased in the presence of GERD. This effect seems to be independent of age, gender, smoking, and alcohol intake.
authors.affiliation: Section of Gastroenterology, The Houston Veterans Affairs Medical Center and Baylor College of Medicine, Texas 77030, USA.
authors.forename: H B
authors.initials: HB
authors.lastname: El-Serag
authors.forename: E J
authors.initials: EJ
authors.lastname: Hepworth
authors.forename: P
authors.initials: P
authors.lastname: Lee
authors.forename: A
authors.initials: A
authors.lastname: Sonnenberg
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010610:Pharyngeal Neoplasms / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014728:Veterans / Q000706:statistics & numerical data