Medications that relax the lower oesophageal sphincter and risk of oesophageal cancer: An analysis of two independent population‐based databases. Issue 1 (8th March 2018)

• Record Type: Journal Article
• Authors: Spence, Andrew D.; Busby, John; Murchie, Peter; Kunzmann, Andrew T.; McMenamin, Úna C.; Coleman, Helen G.; Johnston, Brian T.; O'Rorke, Michael A.; Murray, Liam J.; Iversen, Lisa; Lee, Amanda J.; Cardwell, Chris R.
• Is Part Of: International journal of cancer. Volume 143:Issue 1(2018)
• Page Start: 22
• Page End: 31
• Publication Date: 2018-03-08
• Subjects: oesophageal cancer -- benzodiazepines -- calcium channel blockers -- nitrates -- β2 agonists; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.31293
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract : Excessive lower oesophageal sphincter relaxation increases gastro‐oesophageal acid reflux, an oesophageal adenocarcinoma risk factor. Medications that relax this sphincter (benzodiazepines, calcium channel blockers, nitrates, β2 agonists and xanthines) could promote cancer. These medications were investigated in two independent datasets. In the Scottish Primary Care Clinical Informatics Unit (PCCIU) database, a nested case–control study of oesophageal cancer was performed using GP prescription records. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for medication use and oesophageal cancer. In UK Biobank, a cohort study was conducted using self‐reported medication use. Cox regression was used to calculate hazard ratios (HRs) and 95% CIs for medication use and oesophageal cancer, and by tumour subtype. Overall, 1, 979 oesophageal cancer patients were matched to 9, 543 controls in PCCIU, and 355 of 475, 768 participants developed oesophageal cancer in UK Biobank. None of the medications investigated were significantly associated with oesophageal cancer risk apart from β2 agonists, which were associated with increased oesophageal cancer risk in PCCIU (adjusted OR 1.38, 95% CI 1.12, 1.70) but not in UK Biobank (adjusted HR 1.21, 95% CI 0.70, 2.08). Medications that relax the lower oesophageal sphincter were not associated with oesophageal cancer, apart from β2 agonists. This increased cancer risk in β2 agonist users merits further investigation. Abstract : What's new? Prolonged relaxation of the lower oesophageal sphincter results in increased gastro‐oesophageal reflux, a known risk factor for oesophageal adenocarcinoma. Several common medications have been shown to relax the lower oesophageal sphincter, including benzodiazepines, calcium channel blockers, nitrates, xanthines, and most significantly β2 agonists. Previous studies of associations between these medications and cancer risk have reached inconsistent conclusions, however, potentially reflecting limited statistical power. In the largest study to date using two independent population‐based datasets, medications that decrease sphincter pressure were not associated with increased oesophageal cancer, apart from β2 agonists in one dataset. The β2 agonist association merits further investigation.