If somebody has an anti-reflux surgery, does that eliminate the risk of subsequent esophageal carcinoma? Does that reduce the risk? On what factors does the risk for esophageal carcinoma depend on after anti-reflux surgery? Dr. Jari Rasanen, MD. Yeah, well, the problem is that, if somebody has had GERD reflux in his esophagus for a very long period, then he ends up having anti-reflux surgery. So, the protective effect of anti-reflux surgery isn't complete. It reduces the risk, but the process, which has already started in the mucosa of the esophagus, can still go on. It can still cause esophageal cancer. So, we published a study about 15 years ago, where we researched patients who had anti-reflux surgery. We looked at oxidative stress. We proved that although the mucosal oxidative stress was significantly less after anti-reflux surgery, it was not reduced to zero. So basically, this is a proof that the risk for esophageal cancer is still there after successful anti-reflux surgery. But if the indication for anti-reflux surgery nowadays seems to be more control of the symptoms if you cannot control symptoms with medication. Dr. Jari Rasanen, MD. Then you need to have anti-reflux surgery. So you really cannot say to the patient that it's guaranteed that there will be no cancer after anti-reflux surgery. So this is very interesting. Anti-reflux surgery is used to control symptoms of gastroesophageal reflux disease. Does that still reduce the risk of esophageal carcinoma? Or does the cancer risk stay the same from a statistical point of view? Well, that's a little bit unclear based on our studies. But it seems that the risk of esophageal cancer is reduced. But it's not reduced to zero. So it means that it's impossible to say to an individual, whether he or she will develop esophageal cancer after anti-reflux surgery. So basically, it's other factors, what you need to look at. That is the inflammation in the mucosa. You need to take biopsies from the esophageal mucosa. You look at the inflammation. If the inflammation is still there after the anti-reflux surgery, that's a sign that there is still a risk for esophageal cancer. It doesn't mean that anti-reflux surgery wouldn't decrease the risk for cancer, but it won't make it zero. This is important for patients with gastroesophageal reflux disease.