Alcohol

Alcohol is associated with various types of cancer but what is the risk for acid reflux, Barrett's and Oesophageal Adenocarcinoma?

Cancer Research UK identified 7 types of cancer lined to alcohol: "Drinking alcohol increases the risk of mouth cancer, pharyngeal (upper throat) cancer, oesophageal (food pipe) cancer, laryngeal (voice box) cancer, breast cancer, bowel cancer and liver cancer."

N.B. the "oesophageal cancer" listed above is Squamous Cell Carcinoma (ESCC) affecting the upper oesophagus, rather than the adenocarcinoma (EAC) connected to acid reflux and affecting the lower oesophagus.

"Squamous cell carcinoma is associated with black race, alcohol and smoking, while adenocarcinoma is related to higher body mass index, white race and Barrett's esophagus." (Epidemiological features of esophageal cancer. Squamous cell carcinoma versus adenocarcinoma. 2014)

Is Alcohol bad for acid refluxers?

These studies may suggest it could be.:

"Our systematic review confirmed the expected exposure-dependent relationship of both alcohol and tobacco with the risk of ESCC" (Combination of alcohol , tobacco increases risk of esophageal cancer [squamous cell carcinoma] 2014)

"Although some environmental factors such as ... alcohol ... have been linked with esophageal cancer, further research on the causes of esophageal cancer is intensly warranted" (Etiological Factors of Esophageal Cancer 2015)

"Visceral fat area was independently associated with the presence of reflux esophagitis, but not with the presence of Barrett's esophagus. On the other hand, quantity of alcohol consumption could play a role in the development of severe reflux esophagitis and

Barrett's esophagus in Japanese population."

(Association of Visceral Fat Area, Smoking, and Alcohol Consumption with Reflux Esophagitis and Barrett's Esophagus in Japan 2015

"Our findings suggest that a number of modifiable

pre-diagnosis risk factors have a carryover effect on the risk of death from esophageal cancer. These include smoking, drinking alcohol, and BMI." (Impact of pre-diagnosis behavior on risk of death from esophageal cancer: a systematic review and meta-analysis. 2015)

"EE and BE are prevalent in the community regardless of the presence of GERD. Risk appeared to be additive, increasing substantially with three or more risk factors.

[gender, age, GERD, Caucasian ethnicity, ever tobacco use, excess alcohol use, family history of BE or EAC, and central obesity]" (Prevalence and Predictors of

Gastroesophageal Reflux Complications in Community Subjects. 2016)

"Alcohol effect on gastric motility depends on the alcohol concentration. In general, beverages with high

alcohol concentrations (i.e. above 15 percent) appear to inhibit gastric motility and low alcohol doses (wine and beer) accelerate gastric emptying." (The Effect of Alcohol on Gastrointestinal Motility.2016)

"Multivariable analysis identified the following predictors of cancer: age ≥ 54 years, weight loss, being a drinker of alcohol, and ≤2 gastrointestinal symptoms" (Number of Gastrointestinal Symptoms is a Useful Means of Identifying Patients with Cancer for Dysphagia 2016)

"Severe esophagitis is a rare finding in the Spanish population. Male gender, high GERD-Q score, weight increase and high alcohol consumption are main risk factors for its appearance." (Prevalence of severe esophagitis in Spain. Results of the PRESS study (Prevalence and Risk factors for Esophagitis in Spain: A cross-sectional study) 2016)

In 2019, many newspapers reported that hot coffee caused cancer. The academic study to which they refered was, A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma which found, "drinking 700 mL/day or more at a higher‐temperature (≥60°C) was consistently associated with an about 90% increase in ESCC risk."

Is Alcohol harmless for refluxers?

These studies provide evidence it's probably safe:

"Among dietary factors, low intake of fruit, vegetables, and cereal fibres seem to increase the risk of oesophageal adenocarcinoma. The role of tobacco smoking is probably limited and alcohol consumption is not a risk factor." (Adenocarcinoma of oesophagus: what exactly is the size of the problem and who is at risk? 2005)

"The likely role of smoking in increasing risk of EAC is through promoting progression from BE to cancer."

(No Significant Effects of Smoking or Alcohol Consumption on Risk of Barrett's Esophagus.2013)

"Alcohol drinking is not associated with risk of neoplastic progression in Barrett's esophagus."

(Alcohol Consumption and the Neoplastic Progression in Barrett's Esophagus: A Systematic Review and Meta-Analysis. 2014)

"Consistent with findings for esophageal adenocarcinoma, we found no evidence that alcohol

consumption increases the risk of Barrett's esophagus." (Alcohol and the Risk of Barrett's Esophagus: A Pooled Analysis from the International BEACON Consortium. 2014)

"Long reflux time and family clustering of GOR seem to influence the development of Barrett's oesophagus. Smoking habits, alcohol consumption and BMI do not seem to have any impact on the development of Barrett's oesophagus." (Influence of Life Style Factors on Barrett's Oesophagus 2014)

"overall alcohol consumption was not associated with increased BE incidence. The limited data available on alcohol consumption supports a tentative inversion of alcohol consumption with BE risk in women"

(Alcohol consumption and the risk of Barrett's esophagus: a comprehensive meta-analysis. 2015)

"Overall, there was no significant association between alcohol consumption and BE. ... Significant inverse association was observed between alcohol consumption and BE, for comparisons with population controls."

(Association Between Alcohol Consumption and the Risk of Barrett's Esophagus : A Meta-Analysis of observational Studies. 2015)

"There is recent good evidence that weight reduction and smoking cessation are beneficial in reducing GORD symptoms. Clinical and physiological studies also suggest that some physical measures as well as

modification of meal size and timing can also be

beneficial. However, there is limited evidence for the role of avoiding alcohol and certain dietary ingredients including carbonated drinks, caffeine, fat, spicy foods, chocolate and mint"

(Lifestyle Measures in the Management of Gastro-oesophageal Reflux Disease: Clinical and Pathophysiological Considerations 2015)

"Primary risk factors for BO include male gender, increased age, a family history of the disease, long-standing GORD, smoking, obesity (specifically determined by the waist-to-hip ratio as opposed to BMI), and Caucasian race. Alcohol consumption

and Helicobacter pylori are not associated with

the condition." (Risk Factors for Barrett's Oesophagus. 2016 )

Conclusion

Studies linking alcohol to oesophageal cancer, refer to squamous cell carcinoma or are unspecific.

The balance of findings shows no indication that alcohol in moderation is detrimental to acid reflux sufferers.

Some reports even suggest there may be a beneficial effect.

Further evidence:

"Data linking alcoholic beverages and GERD is ... mixed. A small study in 25 healthy volunteers showed increase in reflux episodes after beer or wine ingestion in comparison to water. This does not correlate with findings in larger cohort studies, such as a case-controlled evaluation of 3,153 patients with GERD in comparison to 40,210 patients without that showed no relationship. Similar findings have been reported in an American population as well as a large cross-sectional analysis of mostly European and North American patients"

(The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn?)