Association of Gastroesophageal Reflux With Malignancy of the Upper Aerodigestive Tract in Elderly Patients

JAMA Otolaryngol Head Neck Surg. 2018 Feb 1;144(2):140-148. doi: 10.1001/jamaoto.2017.2561.


Importance: Chronic inflammatory states have been linked to the development of malignancy. Gastroesophageal reflux disease (GERD) is a known risk factor for esophageal adenocarcinoma as the end result of chronic inflammatory changes.

Objective: To investigate the association of GERD with the risk of malignancy in the upper aerodigestive tract (UADT).

Design, setting, and participants: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to conduct a case-control study of individuals in the United States who had been added from January 2003 through December 2011 and were 66 years or older. The study included patients diagnosed with malignancy of the larynx, hypopharynx, oropharynx, tonsil, nasopharynx, and paranasal sinuses. GERD was examined as an exposure. Controls were matched from a 5% random sample of Medicare beneficiaries without cancer. Multivariable unconditional logistic regression was performed.

Main outcomes and measures: Incidence of invasive malignancies of the UADT.

Results: A total of 13 805 patients (median [range] age, 74 [66-99] years; 3418 women [24.76%] and 10 387 men [75.24%]) with malignancy of the UADT were compared with 13 805 patients without disease and were matched for sex, age group, and year of diagnosis. GERD was associated with a greater odds of developing malignancy of the larynx (adjusted odds ratio [aOR], 2.86; 95% CI, 2.65-3.09), hypopharynx (aOR, 2.54; 95% CI 1.97-3.29), oropharynx (aOR, 2.47; 95% CI, 1.90-3.23), tonsil (aOR, 2.14; 95% CI, 1.82-2.53), nasopharynx (aOR, 2.04; 95% CI, 1.56-2.66), and paranasal sinuses (aOR, 1.40; 95% CI, 1.15-1.70).

Conclusions and relevance: GERD is associated with the presence of malignancy of the UADT in the US elderly population. This epidemiological association requires further examination to determine causality and diagnostic utility.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Comorbidity
  • Female
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / epidemiology*
  • Head and Neck Neoplasms / complications
  • Head and Neck Neoplasms / epidemiology*
  • Humans
  • Longitudinal Studies
  • Male
  • Risk Factors