The Association between Use of Certain Medicines and Cancer of the Esophagus. Ann Intern Med. 2000;133:165. doi: 10.7326/0003-4819-133-3-200008010-00027
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Published: Ann Intern Med. 2000;133(3):165.
The esophagus is the tube that connects the mouth and the stomach. In recent years, the frequency of adenocarcinoma, one of the two main types of cancer of the esophagus, has been increasing while the frequency of squamous-cell cancer, the other type, has stayed the same. Gastroesophageal reflux, a condition in which stomach contents wash up into the esophagus, is thought to contribute to the development of adenocarcinoma of the esophagus. A muscle between the esophagus and stomach, known as the lower esophageal sphincter (LES), normally keeps stomach contents out of the esophagus. Several types of medicines are known to relax this muscle.
To see whether people who take medications that relax the LES have a higher risk for esophageal adenocarcinoma than those who do not take them.
The study included 189 people with esophageal adenocarcinoma, 262 with cancer of the gastric cardia (the junction between the stomach and the esophagus), 167 with esophageal squamous-cell cancer, and 820 who did not have any of these cancers. All study participants lived in Sweden.
The participants completed detailed interviews in which they described their use of five groups of drugs that relax the LES: nitroglycerines (for heart disease), aminophyllines (for lung disease), β-receptor agonists (for lung disease), anticholinergics (muscle relaxants), and benzodiazepines (tranquilizers). The researchers then compared the use of these medications in persons with and those without the various cancers.
Persons who used any of the five medicines daily for more than 5 years were almost four times more likely to develop esophageal adenocarcinoma than were those who never used them. However, this type of cancer is rare; 15,490 men would need to take one of these medicines daily for more than 5 years before their use would result in one additional case of esophageal adenocarcinoma. Gastric cardia cancer and esophageal squamous-cell cancer were not associated with the medicines studied.
Patients with cancer might be more likely than persons without cancer to remember what drugs they had taken. The study did not include all medicines that can relax the LES. In addition, the health conditions being treated with the medicines, rather than the medicines themselves, might have caused the increased risk of esophageal adenocarcinoma.
The risk for esophageal adenocarcinoma may be increased in persons who regularly and for long periods use medicines that relax the muscle between stomach and esophagus. However, the overall risk for this type of cancer remains very small. At most, these medicines contribute to about 10 of every 100 cases of esophageal adenocarcinoma.
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The summary below is from the full report titled “Association between Medications That Relax the Lower Esophageal Sphincter and Risk for Esophageal Adenocarcinoma” It is in the 1 August 2000 issue of Annals of Internal Medicine (volume 133, pages 165-175). The authors are J. Lagergren, R. Bergström, H.-O. Adami, and O. Nyrén.
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Gastroenterology/Hepatology, Hematology/Oncology, Esophageal Disorders, Gastrointestinal Cancer.
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