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Esophageal Cancer Prevention (PDQ®): Prevention - Health Professional Information [NCI] - Summary of Evidence

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Helicobacter pyloriinfection and gastric atrophy

Based on fair evidence, serum CagA antibodies and gastric atrophy are associated with an increased risk of esophageal squamous cell carcinoma (OR = 2.1; 95% CI, 1.1–4.0 and OR = 4.3; 95% CI, 1.9–9.6, respectively).[6]

Description of the Evidence

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Fair.
  • Consistency: Large study.
  • Magnitude of Effects on Health Outcomes: Unknown magnitude.
  • External Validity: Fair.

Adenocarcinoma of the Esophagus

Gastroesophageal reflux/Barrett esophagus

Based on fair evidence, an association exists between gastroesophageal reflux disease (GERD) and adenocarcinoma.[7,8] Long-standing GERD is associated with the development of Barrett esophagus, a condition in which an abnormal intestinal type epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus.

It is unknown whether elimination of gastroesophageal reflux by surgical or medical means will reduce the risk of esophageal adenocarcinoma.[8,9]

Description of the Evidence

  • Study Design: Ecologic and descriptive studies.
  • Internal Validity: Fair.
  • Consistency: Good; multiple studies.
  • Magnitude of Effects on Health Outcomes: Unknown.
  • External Validity: Fair.

Aspirin and nonsteroidal anti-inflammatory drug use

Based on fair evidence, epidemiologic studies have found that aspirin or NSAID use is associated with decreased risk of developing or dying from esophageal cancer (OR = 0.57; 95% CI, 0.47–0.71).[5]

Description of the Evidence

  • Study Design: Evidence obtained from cohort or case-control studies.
  • Internal Validity: Fair.
  • Consistency: Good.
  • Magnitude of Effects on Health Outcomes: Positive; unknown magnitude.
  • External Validity: Fair.

Based on solid evidence, harms of NSAID use include upper gastrointestinal bleeding and serious cardiovascular events such as myocardial infarction, heart failure, hemorrhagic stroke, and renal impairment.

Description of the Evidence

  • Study Design: Evidence obtained from randomized controlled trials.
  • Internal Validity: Good.
  • Consistency: Good.
  • Magnitude of Effects on Health Outcomes: Increased risk, small magnitude.
  • External Validity: Good.

Ablation of Barrett Esophagus With Dysplasia

A randomized controlled trial has found that radiofrequency ablation of Barrett esophagus with severe dysplasia may lead to eradication of both dysplasia and intestinal metaplasia, and a reduced risk of disease progression.[10]

  • Study Design: Evidence obtained from a randomized controlled trial.
  • Internal Validity: Good.
  • Consistency: Single study.
  • Magnitude of Effects on Health Outcomes: Impact on cancer mortality not known.
  • External Validity: Good.
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