Study finds that oesophageal adenocarcinoma cases tripled in younger people over past 30 years

5th October 2021

Oesophageal cancer cases have tripled in under 50s over the past 30 years, a study presented at UEG Week Virtual 2021 has found.

The research, conducted in the Netherlands on almost 60,000 patients, found new cases of oesophageal adenocarcinoma had risen from 0.34 to 0.92 per 100,000 population between 1989 and 2018. There was an average increase of 1.5% in males and 3% in females. The dramatic increases were seen in patients under the age of 50 years old with oesophageal adenocarcinoma.

Experts believe that the rise in cases of oesophageal adenocarcinoma reflect changes in lifestyle-related risk factors for the disease, with increases in unhealthy habits including smoking, poor diet and reduced physical exercise.

Ali Al-Kaabi, from Radboud University Medical Centre in Nijmegen, Netherlands, and lead author of the study, explained, “The incidence of oesophageal adenocarcinoma is increasing in young adults. We know the disease is associated with Barrett’s oesophagus, which is a premalignant condition in the lower end of the oesophagus. Gastro-oesophageal reflux (acid reflux), obesity and smoking are also important risk factors for oesophageal adenocarcinoma. We also know that rates of these risk factors have all increased in young adults over the past 30 years.”

Oesophageal cancer is the seventh most common cancer worldwide and it is a highly fatal disease, accounting for 500,000 deaths each year. There are two main subtypes: oesophageal adenocarcinoma, which is linked to obesity and gastro-oesophageal reflux disease, and oesophageal squamous cell carcinoma, which is linked to alcohol and tobacco consumption.

Although patients under the age of 50 were more likely to be diagnosed at an incurable stage compared to those aged 50-74 and over 74 years (47%, 40% and 29% respectively), younger patients were more likely to undergo multimodality treatments and relative survival for the younger age group rose accordingly in comparison to older patients.

Over the study period, the highest survival rates were seen in under 50s with early-stage diseases, with their five-year survival increasing to 99% (+52%). Those who were classed as ‘potentially curable’ had a five-year survival rate of 46% (+22%), whilst incurable or palliative patients had an one-year survival rate of 32% (+11%).

“Relative survival has markedly improved in the younger age group, with a widening survival gap in comparison to older adults”, commented Ali Al-Kaabi. “These differences may reflect the fact that younger patients are more likely to be treated more aggressively with multiple treatments, including chemoradiotherapy followed by surgery, helping either to provide a cure or prolong patient life.

There are many symptoms for oesophageal cancer, but they can often be difficult to spot and confused with other gastrointestinal symptoms. These include having problems swallowing, feeling or being sick, heartburn and indigestion.

“Based on these study findings, it is important that adults under 50 are aware of these oesophageal cancer symptoms to enable earlier diagnosis and a higher chance of survival”, furthered Ali Al-Kaabi. “This is especially important in high-risk groups, including those that smoke, those with obesity, or those that have high levels of alcohol consumption.”

Gas-related intestinal symptoms are associated with psychological distress and poorer quality of life

4th October 2021

Study presented at UEG Week Virtual 2021 looked at prevalence of gas-related intestinal symptoms in adults, and their association with psychological distress and a poorer quality of life.

Gas-related symptoms are associated with poorer quality of life, and higher stress, anxiety, and depression, with breaking wind being the most frequently reported gas issue, affecting eight out of 10 adults in the general population (81.3%) in a 24-hour period.
 
Other gas-related symptoms included stomach rumbling, which affected 60.5% of respondents, closely followed by belching (58%), and bad breath (48.1%). Trapped wind (47.2%), abdominal distension (39.6%) and bloating/abdominal pressure (38.5%) also had a noticeable impact, while only 11.1% of respondents reported having no gas symptoms. On average, survey participants had been affected by three different gas symptoms within the previous 24-hour period. 
 
The findings from the study, which surveyed nearly 6000 people across the United States, UK, and Mexico, were based on a representative sample of people aged 18 to 99 years asked to fill out validated Intestinal Gas Questionnaires (IGQs) via the internet, to measure the presence and severity of 7 gas-related symptoms in the last 24 hours. Researchers also collected information on body mass index, exercise, emotional wellbeing, and quality of life in the past 7 days.
 
The survey, conducted by scientists from the Rome Foundation Research Institute in the US in collaboration with Danone Nutricia Research in France, revealed that higher IGQ scores correlated with lower mental health and quality of life scores on the PROMIS Global-10 questionnaire, higher stress, anxiety, and depression, and more non-gastrointestinal (GI) symptoms. However, IGC scores did not correlate with weight/BMI and only had a modest negative association with the amount of exercise taken.
 
Younger people aged 18 to 34 and 35 to 49 had the highest overall burden of gas-related symptoms, with IGQ total scores of 24 and 22.6 respectively, compared to 12.7 in people aged 50 to 64 and 8.6 in the over 65s. People in Mexico had higher scores for all seven gas symptoms in IGQ questionnaires, and a higher average IGQ total score, of 26 compared to 14.5 in the US and 13.7 in the UK.
 
Lead author, Professor Olafur Palsson from the University of North Carolina Department of Medicine, said: “I think the most remarkable and surprising finding in our study is that almost all adults in the general population experience some daily gas-related symptoms. This is important given the data also clearly reveals that these symptoms affect people’s general wellbeing. Having a high amount of these common intestinal symptoms is associated with higher levels of depression, anxiety and stress, as well as impaired general quality of life.”
 
He added, “The reasons for the marked differences in the amount of gas-related symptoms between Mexico and the other countries we surveyed are unknown, and need to be investigated further. Cultural, linguistic, diet or public health factors might affect population levels of gas-related symptoms.”
 
The survey methods used included the IGQ, the Patient Health Questionnaire non-GI physical symptoms (PHQ-12) and anxiety and depression (PHQ-4) scales, the PROMIS Global-10 QoL questionnaire and questions on exercises amount, height, weight, and life stress.