PWE-156 Gastro-Oesophageal Reflux Disease (GORD) Symptomatology is not a Reliable Predictor of Oesophageal Adenocarcinoma

Abstract

Introduction Chronic gastro-oesophageal reflux disease (GORD) is considered a risk factor for development of gastro-oesophageal junction adenocarcinoma. Our aim is to determine the prevalence of GORD symptomatology and Barrett's columnar metaplasia prior to the diagnosis of distal oesophageal, gastro-oesophageal junction (GOJ) and gastric cardia adenocarcinoma at GCDD over a 10 year period. Methods A prospective pilot study collected data from patients diagnosed with adenocarcinomas arising from the distal oesophagus, GOJ and cardia in one year. A standardised proforma was designed to capture demographics, clinico-pathological and endoscopic data including the relationship of tumour epicentre with the distal end of the tubular oesophagus, the presence or absence of Barrett's oesophagus; history of recurrent heartburn or regurgitation. To avoid reversed causality, we disregarded symptoms that occurred less than five years prior to cancer diagnosis. Results 37 patients were diagnosed with adenocarcinoma of lower oesophagus and cardia between January and December 2011. 73.5% of patients were male and the age at diagnosis ranged between 45 and 97 years. Only 32% of diagnosed cancers were referred through -Urgent suspected cancer' pathway. 43% of patients were smokers and 28% were ex-smokers; 55% drank alcohol regularly. Only 6 out of 37 patients had chronic symptoms (more than 5 years duration) suggestive of reflux including nausea, heartburn and sore tongue. 62% of these patients were on proton pump inhibitors or Histamine blockers at the time of diagnosis. 20% of the endoscopies showed a large hiatus hernia at index endoscopy and 20% showed evidence of Barrett's (length between 6 and 11cm). Only 30% of patients were treated with curative intervention and the rest were managed by palliative means. 63.8% of diagnosed patients were not alive at one year of follow up out of which one patient had treatment with curative intent, Correlation testing between GORD and diagnosis of GOJ adenocarcinoma using regression analysis did not reach statistical significance. Conclusion This interim report did not reveal a significant correlation between chronic reflux and development of gastrointestinal adenocarcinoma. The number is too small to permit a firm conclusion and we will report further results upon completion of the 10 years.