Concurrence of Reflux Disease and Colonic Neoplasia

Prolonged inhibition of gastric acid secretion may constitute a risk factor for colon polyps (CP) and colorectal cancer (CRC). We hypothesized that esophageal diseases treated with antisecretory medications may be associated with an increased frequency of CP and CRC.

In a case-control studies using the University of Pennsylvania Health System (UPenn) electronic database, we examined the occurrence of eosinophilic esophagitis (EoE), nonerosive reflux disease (NERD), erosive esophagitis (EE), or Barrett's esophagus (BE), in patients with CP or CRC. For comparisons of cases (with CP or CRC) and control subjects (without CP or CRC), we calculated odds ratios (OR) with their 95% CI, using multivariate logistic regressions to adjust for the confounding influences of demographic characteristics (age, sex, and race/ethnicity).

The UPenn database contained 89,100 individual patients who underwent a colonoscopy and EGD between January 2000 and December 2024. Among these, 35,841 were diagnosed with CP and 3,228 with CRC. A total of 2137 patients were diagnosed with EoE, 18,223 with EE, 57,397 with NERD, and 6614 with BE. CPs were significantly associated with EoE (OR: 1.17, 95% CI: 1.07-1.28), EE (OR: 1.71, 95% CI: 1.65-1.77), NERD (OR: 1.76, 95% CI: 1.71-1.81), and BE (OR: 1.80, 95% CI: 1.71-1.90). CRC was significantly associated with BE (OR: 1.22, 95% CI: 1.08-1.33), but no other types of esophageal disease.

The occurrence of any type of reflux disease is associated with an increased risk for colonic neoplasia. Long-term inhibition of gastric acid secretion by antisecretory medication may constitute a risk factor for the occurrence of colon polyps and possibly colorectal cancer.