Risk factors in the development of esophageal adenocarcinoma

This month's issue of the American Journal of Gastroenterology investigates at what stage known risk factors exert their influence toward the progression to cancer.

It is assumed that esophageal adenocarcinoma is the end result of a stepwise disease process that transitions through gastroesophageal reflux disease (GERD) and Barrett's esophagus.

Dr Heiko Pohl and colleagues from Vermont, USA examined at what stage known risk factors exert their influence toward the progression to cancer.

The researchers enrolled 113 consecutive outpatients without GERD, 188 with GERD, 162 with Barrett's esophagus, and 100 with esophageal adenocarcinoma or high-grade dysplasia (HGD).

All patients underwent a standard upper endoscopy and completed a standardized questionnaire about their social history, symptoms, dietary habits, and prescribed medications.

The research team used adjusted logistic regression analysis to assess risk factors between each two consecutive disease stages from the absence of reflux disease to esophageal adenocarcinoma.

Hiatal hernia was the only risk factor to be strongly associated with GERD

American Journal of Gastroenterology

Overall, male gender, smoking, increased body mass index (BMI), low fruit and vegetable intake, duration of reflux symptoms, and presence of a hiatal hernia were risk factors for cancer/HGD.

The team noted that different combinations of risk factors were associated with different disease stages.

Hiatal hernia was the only risk factor to be strongly associated with the development of GERD.

For GERD patients, male gender, age, an increased BMI, duration of reflux symptoms, and presence of a hiatal hernia were all associated with the development of Barrett's esophagus.

The research team observed that the development of cancer/HGD among patients with Barrett's esophagus was associated with male gender, smoking, decreased fruit and vegetable intake, and a long segment of Barrett's esophagus, but not with age, BMI, or a hiatal hernia.

Dr Pohl's team concluded, "While some risk factors act predominantly on the initial development of reflux disease, others appear to be primarily responsible for the development of more advanced disease stages."