Meta-analysis: the association of oesophageal adenocarcinoma with symptoms of gastro-oesophageal reflux.
BACKGROUND
Endoscopic screening has been proposed for patients with symptoms of gastro-oesophageal reflux disease (GERD) in the hope of reducing mortality from oesophageal adenocarcinoma. Assessing the net benefits of such a strategy requires a precise understanding of the cancer risk in the screened population.


OBJECTIVE
To estimate precisely the association between symptoms of GERD and oesophageal adenocarcinoma.


METHODS
Systematic review and meta-analysis of population-based studies with strict ascertainment of exposure and outcomes.


RESULTS
Five eligible studies were identified. At least weekly symptoms of GERD increased the odds of oesophageal adenocarcinoma fivefold (odds ratio = 4.92; 95% confidence interval = 3.90, 6.22), and daily symptoms increased the odds sevenfold (random effects summary odds ratio = 7.40, 95% confidence interval = 4.94, 11.1), each compared with individuals without symptoms or less frequent symptoms. Duration of symptoms was also associated with oesophageal adenocarcinoma, but with very heterogeneous results, and unclear thresholds.


CONCLUSIONS
Frequent GERD symptoms are strongly associated with oesophageal adenocarcinoma. These results should be useful in developing epidemiological models of the development of oesophageal adenocarcinoma, and in models of interventions aimed at reducing mortality from this cancer.
Veterans Affairs Center of Excellence for Clinical Management Research, Ann Arbor, MI, USA. jhr@umich.edu
J H
JH
Rubenstein
J B
JB
Taylor
D000230:Adenocarcinoma / Q000150:complications* / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000150:complications* / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D012307:Risk Factors