Medications that relax the lower oesophageal sphincter and risk of oesophageal cancer: An analysis of two independent population-based databases

Andrew D Spence (Corresponding Author), John Busby, Peter Murchie, Andrew T Kunzmann, Úna C McMenamin, Helen G Coleman, Brian T Johnston, Michael A O'Rorke, Liam J Murray, Lisa Iversen, Amanda Jane Lee, Chris R Cardwell

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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.
Original languageEnglish
Pages (from-to)22-31
Number of pages11
JournalInternational Journal of Cancer
Volume143
Issue number1
Early online date8 Mar 2018
DOIs
Publication statusPublished - 1 Jul 2018

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Lower Esophageal Sphincter
Esophageal Neoplasms
Databases
Medical Informatics
Population
Confidence Intervals
Primary Health Care
Xanthines
Odds Ratio
Neoplasms
Calcium Channel Blockers
Gastroesophageal Reflux
Benzodiazepines
Nitrates
Prescriptions
Case-Control Studies
Adenocarcinoma
Cohort Studies
Logistic Models
Acids

Keywords

  • β2 agonists
  • Oesophageal cancer
  • Benzodiazepines
  • Calcium channel blockers
  • Nitrates

Cite this

Medications that relax the lower oesophageal sphincter and risk of oesophageal cancer : An analysis of two independent population-based databases. / Spence, Andrew D (Corresponding Author); 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 Jane; Cardwell, Chris R.

In: International Journal of Cancer, Vol. 143, No. 1, 01.07.2018, p. 22-31.

Research output: Contribution to journalArticle

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 Jane ; Cardwell, Chris R. / Medications that relax the lower oesophageal sphincter and risk of oesophageal cancer : An analysis of two independent population-based databases. In: International Journal of Cancer. 2018 ; Vol. 143, No. 1. pp. 22-31.
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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.",
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