Is esophageal adenocarcinoma occurring late after antireflux surgery due to persistent postoperative reflux?

Gastroesophageal reflux is the main risk factor for esophageal adenocarcinoma, but there is no strong support for a protective effect of antireflux surgery. We tested the hypothesis that esophageal adenocarcinoma that develops with long latency after antireflux surgery might be due to persistent postoperative reflux.

A nationwide population-based case-control study in collaboration with 195 relevant Swedish hospital departments and tumor registries during the study period 1995-1997. Frequency-matched control persons were randomly selected from the population register. All study participants were personally interviewed regarding background data, exposures, symptoms, conditions, diseases, surgery, and medications. Differences between cases and controls in the occurrence of daily, long-standing antireflux medication 5 years or later after antireflux surgery were estimated using Fisher's exact test.

One hundred and eighty-nine out of 216 (88%) eligible cases of esophageal adenocarcinoma and 820 of 1,128 (73%) controls were prospectively enrolled. Seven (3.7%) patients and 8 controls had undergone antireflux surgery at least 5 years before the interview. All 7 case patients had Barrett's mucosa. Four of the case patients had used postoperative antireflux medications continuously (mean duration 10.2 years), while none of the control persons reported such use (P = 0.026). There was no difference in mean body mass index between patients with and without postoperative reflux (P = 0.81). No differences between the patients and controls were found regarding age, sex, body mass index, or tobacco smoking status.

Esophageal adenocarcinoma occurring late after antireflux surgery might at least partly be due to persistent postoperative reflux. Further research is required to establish the role of antireflux surgery in the etiology of this tumor.