Children born prematurely are at higher risk of esophageal inflammation, cancer

Infants that are born preterm or with impaired growth have an increased risk of developing gastroesophageal reflux disease (GERD), possibly leaving them vulnerable to the development of esophageal adenocarcinoma later in life. Gestational age and size at birth affect the risk of an early diagnosis of esophagitis—inflammation of the esophagus—according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association.

"Long-term exposure to reflux is a major risk factor for esophageal cancer. Therefore, those exposed to reflux early in life, such as preterm-born infants and children, may face a higher risk of developing esophageal cancer," said Lina Forssell, MD, of the Karolinska Institutet, Stockholm, Sweden and first author of this study. "Having found an increased risk of esophagitis among those born preterm, it is important that we try to quantify their subsequent risk of developing esophageal cancer."

Researchers analyzed data from the Swedish birth register and patient register to identify birth characteristics of individuals with esophagitis from 1973 to 2007. They found that the risk of esophagitis was increased by 170 and 50 percent among individuals born preterm and small for gestational age, respectively. Being small for gestational age at birth was associated with an increased risk of esophagitis in all age groups, whereas short-duration gestation was strongly associated with an increased risk of esophagitis at age 0 to 9 years, moderately associated at ages 10 to 19 years, and not associated at later ages. The overall association between preterm birth and risk of esophagitis was stronger among males than females.

In conclusion:

• Being born very preterm (≤ 32 complete weeks) seems to increase the risk of esophagitis almost three-fold, independent of age at diagnosis.
• Being born very preterm also seems to increase the risk of esophagitis diagnosed before the age of 10 almost seven-fold.
• The effect of preterm birth on the risk of esophagitis is seemingly stronger among males than females.

Among infants, GERD is very common, but usually disappears by the time they turn a year old. However, some children have continuing problems: about 40 to 77 percent of children below the age of 2 with GERD have esophagitis. GERD is also a known risk factor for esophageal cancer.