The incidence of esophageal adenocarcinoma in the western world has been linked to chronic heartburn, regurgitation, and the development of the premalignant epithelium of Barrett's esophagus (BE).
However, up to 40% of esophageal adenocarcinomas occur in patients without prior reflux symptoms.
Writing in the August issue of the journal Gastroenterology, Dr Lauren B. Gerson and colleagues report on their findings of a prospective study of asymptomatic patients for the presence of BE.
The study, which focused on subjects older than 50 years of age, was conducted on patients undergoing screening sigmoidoscopy for colorectal cancer, who were invited to undergo upper endoscopy.
Patients excluded from the study group included those who experienced symptoms of gastroesophageal reflux disease (GERD) more than once a month.
Also excluded were patients using medications for GERD, and those who had undergone a previous endoscopy.
BE was classified as long-segment BE (LSBE), short-segment BE (SSBE), and microscopic specialized intestinal metaplasia of the esophagogastric junction (SIM-EGJ).
| BE was detected in 25% of asymptomatic individuals |
Of 408 potential study candidates, 110 subjects were screened, of whom 9 were women.
The mean age of screened subjects was 61 ± 9.3 (range, 50-80) years, with the majority (73%) being Caucasian.
Intestinal metaplasia extending above the EGJ was detected in 27 (25%) subjects. Of these, 8 (7%) had LSBE and 19 (17%) suffered from SSBE.
The research group found patients with BE were no more likely to be obese, or consumers of tobacco or alcohol, than were those without BE.
Additionally, there was no difference in the reporting of a family history of GERD, any evidence of association with toxic exposure, or use of antacids more than once a month, between BE patients and non-BE patients.
In an accompanying editorial, Dr Nicholas Shaheen of the University of North Carolina at Chapel Hill, USA, said that the report by Dr Gerson and colleagues "provides evidence that using chronic GERD symptoms to find subjects with BE may miss large numbers of effected subjects without GERD symptoms."