Abstract
This large-scale, controlled cohort study estimated the risks of lung cancer in patients with gastro-esophageal reflux disease (GERD) in Taiwan. We conducted this population-based study using data from the National Health Insurance Research Database of Taiwan during the period from 1997 to 2010. Patients with GERD were diagnosed using endoscopy, and controls were matched to patients with GERD at a ratio of 1:4. We identified 15,412 patients with GERD and 60,957 controls. Compared with the controls, the patients with GERD had higher rates of osteoporosis, diabetes mellitus, asthma, chronic obstructive pulmonary disease, pneumonia, bronchiectasis, depression, anxiety, hypertension, dyslipidemia, chronic liver disease, congestive heart failure, atrial fibrillation, stroke, chronic kidney disease, and coronary artery disease (all P < .05). A total of 85 patients had lung cancer among patients with GERD during the follow-up of 42,555 person-years, and the rate of lung cancer was 0.0020 per person-year. By contrast, 232 patients had lung cancer among patients without GERD during the follow-up of 175,319 person-years, and the rate of lung cancer was 0.0013 per person-year. By using stepwise Cox regression model, the overall incidence of lung cancer remained significantly higher in the patients with GERD than in the controls (hazard ratio, 1.53; 95% CI [1.19–1.98]). The cumulative incidence of lung cancer was higher in the patients with GERD than in the controls (P = .0012). In conclusion, our large population-based cohort study provides evidence that GERD may increase the risk of lung cancer in Asians.
Highlights
Gastro-esophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents causes troublesome symptoms and complications (Bredenoord, Pandolfino & Smout, 2013; Moayyedi & Talley, 2006; Vakil et al, 2006)
Because it may cause lung injury from recurrent microaspiration, GERD is associated with the risk of several lung diseases, such as idiopathic pulmonary fibrosis, cystic fibrosis, connective tissue disease, asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (Blondeau et al, 2008; D’Ovidio et al, 2005; Mise et al, 2010; Morehead, 2009; Pacheco-Galvan, Hart & Morice, 2011; Pashinsky, Jaffin & Litle, 2009; Salvioli et al, 2006; Sweet et al, 2009; Patti et al, 2008)
The National Health Insurance Research Database (NHIRD) was used to identify 97,221 patients diagnosed with GERD after undergoing esophagogastroduodenoscopy from January 1, 1997 to December 31, 2010
Summary
Gastro-esophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents causes troublesome symptoms and complications (Bredenoord, Pandolfino & Smout, 2013; Moayyedi & Talley, 2006; Vakil et al, 2006). Because it may cause lung injury from recurrent microaspiration, GERD is associated with the risk of several lung diseases, such as idiopathic pulmonary fibrosis, cystic fibrosis, connective tissue disease, asthma, chronic obstructive pulmonary disease (COPD), and interstitial lung disease (Blondeau et al, 2008; D’Ovidio et al, 2005; Mise et al, 2010; Morehead, 2009; Pacheco-Galvan, Hart & Morice, 2011; Pashinsky, Jaffin & Litle, 2009; Salvioli et al, 2006; Sweet et al, 2009; Patti et al, 2008)
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