Gastroesophageal reflux: a dazzling increase in certain cancers

In addition to increasing the risk of cancer of the esophagus, a study reports that chronic gastroesophageal reflux (known as GERD) doubles the risk of developing cancers of the upper digestive tract, in particular that of the larynx.

Gastroesophageal reflux disease, commonly known as “heartburn”, is a very common problem and a frequent cause of medical consultation. As the name suggests, this phenomenon is caused by an abnormal rise of acidic contents of the stomach into the esophagus, which causes unpleasant symptoms such as a burning sensation and acid regurgitation. In the most severe cases, chronic reflux can over time damage the lining of the esophagus and cause various complications, such as esophageal stricture, chronic inflammation (esophagitis) and development of the endobrachyesophagus.

GERD: dramatic increase in certain cancers

Inflammation of the esophagus due to chronic gastroesophageal reflux is particularly worrisome, as this condition is associated with a phenomenal (30- to 60-fold) increase in the risk of esophageal adenocarcinoma, the main form of cancer that affects this organ. Repeated exposure of cells present at the stomach-oesophageal junction to gastric acid causes replacement (metaplasia) of normal oesophageal tissue with intestinal-like mucosa, which may subsequently develop into adenocarcinoma. Although quite rare, esophageal cancer has increased more than sixfold over the past 40 years, and is currently one of the most rapidly growing cancers.

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Obesity: an aggravating factor in the occurrence of GERD

The reasons for this increase remain poorly understood, but it is certain that an increase of this magnitude in such a short period of time indicates that it is necessarily caused by lifestyle changes and not genetic factors. In this sense, it should be noted that several studies show that obesity is an important risk factor for esophageal cancer, and it is very likely that the sharp increase in the number of overweight people in recent decades contributes to this increased incidence of esophageal adenocarcinomas.

Chronic inflammation of the esophagus sets the stage for cancer

In some cases, acid reflux from the stomach can rise very high in the esophagus and reach the upper digestive tract at the level of the head and neck (throat, sinuses). To determine whether this reflux could also affect the risk of cancer in the organs present in this region, a team of scientists examined the medical records of 13,805 people aged 66 to 99 who had been diagnosed with cancer in this region (larynx , hypopharynx, oropharynx, tonsils, nasopharynx, and paranasal sinuses) and compared them to those from individuals with no history of cancer.

They observed that people who suffered from chronic gastroesophageal reflux had a much higher risk of developing cancer of the larynx (up 300%), pharynx and tonsils (up 200%) and sinuses (up 40%). ). As with the esophagus, it therefore seems that the chronic inflammation of these organs caused by the presence of acidic gastric contents coming from the stomach can cause cellular damage which favors the appearance of transformed cells which can subsequently evolve into cancers.

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Risk factors: obesity, alcohol, acidic dishes and late dining

Gastroesophageal reflux must therefore be considered as inflammatory and carcinogenic aggressors which have the potential to promote the development of tumors in all of the upper digestive tracts. In many cases, however, it is possible to reduce the frequency and/or intensity of these refluxes by simple lifestyle changes:

– As reflux is more frequent at night (when lying down, gravity cannot counteract the rise in acid), it is recommended to dine earlier and eat less to promote emptying of the stomach before going to bed .

-Certain foods are known to release the pressure of the lower esophageal sphincter and therefore to promote the rise of gastric contents, for example foods rich in fat, coffee and alcohol. Highly acidic foods (tomatoes, citrus juices, soft drinks) can also cause gastric reflux in many people.

– Maintain a healthy weight as much as possible: as mentioned above, obesity is a major risk factor for gastroesophageal reflux disease.

Riley CA et al. Association of gastroesophageal reflux with malignancy of the upper aerodigestive tract in elderly patients. JAMA Otolaryngol Head Neck Surg. December 21, 2017.

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