Gastroesophageal reflux disease and head and neck cancers: A systematic review and meta-analysis

Am J Otolaryngol. 2020 Nov-Dec;41(6):102653. doi: 10.1016/j.amjoto.2020.102653. Epub 2020 Aug 5.


Purpose: Gastroesophageal reflux disease (GERD) has been associated with head and neck cancer (HNC), including laryngeal and pharyngeal anatomical sites. A systematic review and meta-analysis was performed to examine these associations.

Methods: Articles were retrieved from the Medline, Web of Science, Scopus, and Embase databases using keywords "gastroesophageal reflux disease", "laryngopharyngeal reflux", "head and neck cancer", and associated variants. Inclusion criteria were English language publications, human subjects, and controlled studies with described development of head and neck cancer among individuals with GERD. 13 studies with a total of 39,824 patients were included.

Results: Overall, presence of GERD was associated with an increased risk of developing HNC (OR = 1.86, 95% Confidence Interval [CI] = 1.27-2.74). This association remained significant with laryngeal cancers (OR = 1.95, 95% CI = 1.33-2.86), but not pharyngeal cancers (OR = 1.56, 95% CI = 0.86-2.83). Subgroup analyses of hypopharyngeal (OR = 2.26, 95% CI = 0.67-7.68) and oropharyngeal subsites (OR = 1.39, 95% CI = 0.51-3.84) were not statistically significant. Meta-analysis of studies that objectively assessed reflux, such as pH monitor placement, showed statistical significance (OR = 2.81, 95% CI = 1.36-5.81), while studies that used subjective reporting or chart review of GERD were not significant (OR = 1.46, 95% CI = 0.89-2.40). Association between H. pylori infection and head and neck cancers was not statistically significant (OR = 2.66, 95% CI = 0.59-11.97).

Conclusion: A diagnosis of GERD is associated with a later diagnosis of HNC, but this association is not significant for pharyngeal cancers. Associations of GERD with HNC may be specific to laryngeal cancers.

Level of evidence: Systematic review and meta-analysis of case control studies (3a).

Keywords: GERD; Gastroesophageal reflux disease; Head and neck cancer; Laryngeal cancer; Laryngopharyngeal reflux; Pharyngeal cancer.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Esophageal pH Monitoring
  • Female
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / diagnosis
  • Head and Neck Neoplasms / epidemiology
  • Head and Neck Neoplasms / etiology
  • Humans
  • Laryngeal Neoplasms / epidemiology
  • Laryngeal Neoplasms / etiology*
  • Male
  • Pharyngeal Neoplasms
  • Risk