Skip to main content

Advertisement

SpringerLink
Log in

Barrett’s esophagus and esophageal adenocarcinoma in adults: Long-term GERD or something else?

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Esophageal adenocarcinoma (EAC) is a highly lethal tumor and is currently the most rapidly rising incidence cancer in the Western world. Numerous risk factors in the development of Barrett’s esophagus (BE) (a precursor of EAC) and EAC itself have been identified and are likely multifactorial. Gastroesophageal reflux disease (GERD) is a significant risk factor for BE and EAC; however, only a minority of patients with chronic GERD actually develop BE. Thus, other risk factors that modulate reflux-related inflammatory and neoplastic effects on esophageal epithelium must exist. Epidemiologic data have prompted initiation of chemopreventive trials using aspirin and proton pump inhibitors in the treatment of BE and EAC. Further research should also clarify the role of risk factors such as ethnicity and obesity in BE and EAC development and progression. Identification of prognostic factors would allow better risk stratification of patients and ultimately impact the rising incidence of EAC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Blot WJ, McLaughlin JK: The changing epidemiology of esophageal cancer. Semin Oncol 1999, 26:2–8.

    PubMed  CAS  Google Scholar 

  2. Shaheen NJ: Advances in Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterology 2005, 128:1554–1566.

    Article  PubMed  Google Scholar 

  3. Pisani P, Parkin DM, Bray F, et al.: Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer 1999, 83:18–29.

    Article  PubMed  CAS  Google Scholar 

  4. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2007. CA Cancer J Clin 2007, 57:43–66.

    Article  PubMed  Google Scholar 

  5. Eloubeidi MA, Mason AC, Desmond RA, et al.: Temporal trends (1973–1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope? Am J Gastroenterol 2003, 98:1627–1633.

    PubMed  Google Scholar 

  6. Sharma P, McQuaid K, Dent J, et al.: A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop. Gastroenterology 2004, 127:310–330.

    Article  PubMed  Google Scholar 

  7. Ronkainen J, Aro P, Storskrubb T, et al.: Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology 2005, 129:1825–1831.

    Article  PubMed  Google Scholar 

  8. Cameron AJ, Zinsmeister AR, Ballard DJ, et al.: Prevalence of columnar-lined (Barrett’s) esophagus. Comparison of population-based clinical and autopsy findings. Gastroenterology 1990, 99:918–922.

    PubMed  CAS  Google Scholar 

  9. Lagergren J: Adenocarcinoma of oesophagus: what exactly is the size of the problem and who is at risk? Gut 2005, 54(Suppl 1):i1–i5.

    Article  PubMed  Google Scholar 

  10. Sampliner RE: Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol 2002, 97:1888–1895.

    Article  PubMed  Google Scholar 

  11. Buttar NS, Wang KK, Leontovich O, et al.: Chemoprevention of esophageal adenocarcinoma by COX-2 inhibitors in an animal model of Barrett’s esophagus. Gastroenterology 2002, 122:1101–1112.

    Article  PubMed  CAS  Google Scholar 

  12. Li H, Walsh TN, O’Dowd G, et al.: Mechanisms of columnar metaplasia and squamous regeneration in experimental Barrett’s esophagus. Surgery 1994, 115:176–181.

    PubMed  CAS  Google Scholar 

  13. Lieberman DA, Oehlke M, Helfand M: Risk factors for Barrett’s esophagus in community-based practice. GORGE consortium. Gastroenterology Outcomes Research Group in Endoscopy. Am J Gastroenterol 1997, 92:1293–1297.

    PubMed  CAS  Google Scholar 

  14. Chak A, Ochs-Balcom H, Falk G, et al.: Familiality in Barrett’s esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction. Cancer Epidemiol Biomarkers Prev 2006, 15:1668–1673.

    Article  PubMed  Google Scholar 

  15. Wani S, Rastogi A, Bansal A, et al.: Reflux symptom profiles are not different in GERD patients with and without Barrett’s esophagus. Gastroenterology 2007, 132(Suppl 2):A469.

    Google Scholar 

  16. Gerson LB, Edson R, Lavori PW, et al.: Use of a simple symptom questionnaire to predict Barrett’s esophagus in patients with symptoms of gastroesophageal reflux. Am J Gastroenterol 2001, 96:2005–2012.

    Article  PubMed  CAS  Google Scholar 

  17. Rex DK, Cummings OW, Shaw M, et al.: Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn. Gastroenterology 2003, 125:1670–1677.

    Article  PubMed  Google Scholar 

  18. Lagergren J, Bergstrom R, Lindgren A, et al.: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999, 340:825–831.

    Article  PubMed  CAS  Google Scholar 

  19. Farrow DC, Vaughan TL, Sweeney C, et al.: Gastroesophageal reflux disease, use of H2 receptor antagonists, and risk of esophageal and gastric cancer. Cancer Causes Control 2000, 11:231–238.

    Article  PubMed  CAS  Google Scholar 

  20. Chak A, Faulx A, Eng C, et al.: Gastroesophageal reflux symptoms in patients with adenocarcinoma of the esophagus or cardia. Cancer 2006, 107:2160–2166.

    Article  PubMed  Google Scholar 

  21. Cameron AJ, Lomboy CT: Barrett’s esophagus: age, prevalence, and extent of columnar epithelium. Gastroenterology 1992, 103:1241–1245.

    PubMed  CAS  Google Scholar 

  22. Eloubeidi MA, Provenzale D: Clinical and demographic predictors of Barrett’s esophagus among patients with gastroesophageal reflux disease: a multivariable analysis in veterans. J Clin Gastroenterol 2001, 33:306–309.

    Article  PubMed  CAS  Google Scholar 

  23. Guardino JM, Khandwala F, Lopez R, et al.: Barrett’s esophagus at a tertiary care center: association of age on incidence and prevalence of dysplasia and adenocarcinoma. Am J Gastroenterol 2006, 101:2187–2193.

    Article  PubMed  Google Scholar 

  24. El-Serag HB, Mason AC, Petersen N, et al.: Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut 2002, 50:368–372.

    Article  PubMed  CAS  Google Scholar 

  25. Sampliner RE, Eisen GM, De Garmo P: Ethnicity and gender of patients with suspected Barrett’s esophagus in a large endoscopy cohort (CORI) [abstract]. Gastrointest Endosc 2001, 53:AB151.

    Article  Google Scholar 

  26. Wani S, Rastogi A, Bansal A, et al.: Symptom profiles and endoscopic findings in African-American patients with gastroesophageal reflux disease (GERD). Gastroenterology 2007, 132(Suppl 2):A161.

    Google Scholar 

  27. Abrams JA, Fields S, Lightdale CJ, et al.: Racial and ethnic differences in the prevalence of Barrett’s esophagus among patients who undergo upper endoscopy. Gastroenterology 2007, 132:x–xvii.

    Article  Google Scholar 

  28. Kubo A, Corley DA: Marked multi-ethnic variation of esophageal and gastric cardia carcinomas within the United States. Am J Gastroenterol 2004, 99:582–588.

    Article  PubMed  Google Scholar 

  29. Ogden CL, Yanovski SZ, Carroll MD, et al.: The epidemiology of obesity. Gastroenterology 2007, 132:2087–2102.

    Article  PubMed  Google Scholar 

  30. Hampel H, Abraham NS, El-Serag HB: Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 2005, 143:199–211.

    PubMed  Google Scholar 

  31. Kubo A, Corley DA: Body mass index and adenocarcinomas of the esophagus or gastric cardia: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2006, 15:872–878.

    Article  PubMed  Google Scholar 

  32. Stein DJ, El-Serag HB, Kuczynski J, et al.: The association of body mass index with Barrett’s oesophagus. Aliment Pharmacol Ther 2005, 22:1005–1010.

    Article  PubMed  CAS  Google Scholar 

  33. Smith KJ, O’Brien SM, Smithers BM, et al.: Interactions among smoking, obesity, and symptoms of acid reflux in Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev 2005, 14:2481–2486.

    Article  PubMed  Google Scholar 

  34. El-Serag HB, Kvapil P, Hacken-Bitar J, et al.: Abdominal obesity and the risk of Barrett’s esophagus. Am J Gastroenterol 2005, 100:2151–2156.

    Article  PubMed  Google Scholar 

  35. Corley DA, Kubo A, Levin TR, et al.: Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology 2007, 133:34–41.

    Article  PubMed  Google Scholar 

  36. Wani S, Bansal A, Rastogi A, et al.: The relationship between body mass index (BMI) and Barrett’s esophagus (BE). Gastroenterology 2007, 132(Suppl 2):A257.

    Google Scholar 

  37. Weinsier RL, Hunter GR, Gower BA, et al.: Body fat distribution in white and black women: different patterns of intraabdominal and subcutaneous abdominal adipose tissue utilization with weight loss. am J Clin Nutr 2001, 74:631–636.

    PubMed  CAS  Google Scholar 

  38. Vaughan TL, Kristal AR, Blount PL, et al.: Nonsteroidal anti-inflammatory drug use, body mass index, and anthropometry in relation to genetic and flow cytometric abnormalities in Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev 2002, 11:745–752.

    PubMed  Google Scholar 

  39. Chak A, Lee T, Kinnard MF, et al.: Familial aggregation of Barrett’s oesophagus, oesophageal adenocarcinoma, and oesophagogastric junctional adenocarcinoma in Caucasian adults. Gut 2002, 51:323–328.

    Article  PubMed  CAS  Google Scholar 

  40. Lagergren J, Ye W, Lindgren A, et al.: Heredity and risk of cancer of the esophagus and gastric cardia. Cancer Epidemiol Biomarkers Prev 2000, 9:757–760.

    PubMed  CAS  Google Scholar 

  41. Dhillon PK, Farrow DC, Vaughan TL, et al.: Family history of cancer and risk of esophageal and gastric cancers in the United States. Int J Cancer 2001, 93:148–152.

    Article  PubMed  CAS  Google Scholar 

  42. Romero Y, Cameron AJ, Locke GR III, et al.: Familial aggregation of gastroesophageal reflux in patients with Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterology 1997, 113:1449–1456.

    Article  PubMed  CAS  Google Scholar 

  43. Vicari JJ, Peek RM, Falk GW, et al.: The seroprevalence of cagA-positive Helicobacter pylori strains in the spectrum of gastroesophageal reflux disease. Gastroenterology 1998, 115:50–57.

    Article  PubMed  CAS  Google Scholar 

  44. Ackermark P, Kuipers EJ, Wolf C, et al.: Colonization with cagA-positive Helicobacter pylori strains in intestinal metaplasia of the esophagus and the esophagogastric junction. Am J Gastroenterol 2003, 98:1719–1724.

    Article  PubMed  Google Scholar 

  45. Jobe BA, Hunter JG, Chang EY, et al.: Office-based unsedated small-caliber endoscopy is equivalent to conventional sedated endoscopy in screening and surveillance for Barrett’s esophagus: a randomized and blinded comparison. Am J Gastroenterol 2006, 101:2693–2703.

    Article  PubMed  Google Scholar 

  46. Chow WH, Blaser MJ, Blot WJ, et al.: An inverse relation between cagA+ strains of Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. Cancer Res 1998, 58:588–590.

    PubMed  CAS  Google Scholar 

  47. Ye W, Held M, Lagergren J, et al.: Helicobacter pylori infection and gastric atrophy: risk of adenocarcinoma and squamous cell carcinoma of the esophagus and gastric cardia adenocarcinoma. J Natl Cancer Inst 2004, 96:388–396.

    PubMed  Google Scholar 

  48. Wu AH, Crabtree JE, Bernstein L, et al.: Role of Helicobacter pylori CagA+ strains and risk of adenocarcinoma of the stomach and esophagus. Int J Cancer 2003, 103:815–821.

    Article  PubMed  CAS  Google Scholar 

  49. Caygill CP, Johnston DA, Lopez M, et al.: Lifestyle factors and Barrett’s esophagus. Am J Gastroenterol 2002, 97:1328–1331.

    Article  PubMed  Google Scholar 

  50. Freedman ND, Abnet CC, Leitzmann MF, et al.: A prospective study of tobacco, alcohol, and the risk of esophageal and gastric cancer subtypes. Am J Epidemiol 2007, 165:1424–1433.

    Article  PubMed  Google Scholar 

  51. Lagergren J, Bergstrom R, Lindgren A, et al.: The role of tobacco, snuff and alcohol use in the aetiology of cancer of the oesophagus and gastric cardia. Int J Cancer 2000, 85:340–346.

    Article  PubMed  CAS  Google Scholar 

  52. Wu AH, Wan P, Bernstein L: A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinomas of the stomach and esophagus (United States). Cancer Causes Control 2001, 12:721–732.

    Article  PubMed  CAS  Google Scholar 

  53. Ford AC, Forman D, Reynolds PD, et al.: Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett’s esophagus. Am J Epidemiol 2005, 162:454–460.

    Article  PubMed  Google Scholar 

  54. Jansson C, Johansson AL, Nyren O, et al.: Socioeconomic factors and risk of esophageal adenocarcinoma: a nationwide Swedish case-control study. Cancer Epidemiol Biomarkers Prev 2005, 14:1754–1761.

    Article  PubMed  Google Scholar 

  55. Terry P, Lagergren J, Hansen H, et al.: Fruit and vegetable consumption in the prevention of oesophageal and cardia cancers. Eur J Cancer Prev 2001, 10:365–369.

    Article  PubMed  CAS  Google Scholar 

  56. Mayne ST, Risch HA, Dubrow R, et al.: Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev 2001, 10:1055–1062.

    PubMed  CAS  Google Scholar 

  57. Anderson LA, Watson RG, Murphy SJ, et al.: Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: results from the FINBAR study. World J Gastroenterol 2007, 13:1585–1594.

    PubMed  Google Scholar 

  58. Kubo A, Corley DA: Meta-analysis of antioxidant intake and the risk of esophageal and gastric cardia adenocarcinoma. Am J Gastroenterol 2007, [In press].

  59. Rudolph RE, Vaughan TL, Kristal AR, et al.: Serum selenium levels in relation to markers of neoplastic progression among persons with Barrett’s esophagus. J Natl Cancer Inst 2003, 95:750–757.

    Article  PubMed  CAS  Google Scholar 

  60. Suzuki H, Iijima K, Scobie G, et al.: Nitrate and nitrosative chemistry within Barrett’s oesophagus during acid reflux. Gut 2005, 54:1527–1535.

    Article  PubMed  CAS  Google Scholar 

  61. Iijima K, Grant J, McElroy K, et al.: Novel mechanism of nitrosative stress from dietary nitrate with relevance to gastro-oesophageal junction cancers. Carcinogenesis 2003, 24:1951–1960.

    Article  PubMed  CAS  Google Scholar 

  62. Lagergren J, Bergstrom R, Adami HO, et al.: Association between medications that relax the lower esophageal sphincter and risk for esophageal adenocarcinoma. Ann Intern Med 2000, 133:165–175.

    PubMed  CAS  Google Scholar 

  63. Corley DA, Kubo A: Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol 2006, 101:2619–2628.

    Article  PubMed  Google Scholar 

  64. El-Serag HB, Aguirre TV, Davis S, et al.: Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett’s esophagus. Am J Gastroenterol 2004, 99:1877–1883.

    Article  PubMed  CAS  Google Scholar 

  65. de Jonge PJ, Steyerberg EW, Kuipers EJ, et al.: Risk factors for the development of esophageal adenocarcinoma in Barrett’s esophagus. Am J Gastroenterol 2006, 101:1421–1429.

    Article  PubMed  Google Scholar 

  66. Sharma P, Sampliner RE, Camargo E: Normalization of esophageal pH with high-dose proton pump inhibitor therapy does not result in regression of Barrett’s esophagus. Am J Gastroenterol 1997, 92:582–585.

    PubMed  CAS  Google Scholar 

  67. Corley DA, Kerlikowske K, Verma R, et al.: Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 2003, 124:47–56.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Veterans Affairs Medical Center, 4801 East Linwood Boulevard, Kansas City, MO, 64128, USA

    Prateek Sharma

Authors
  1. Krishna Pondugula
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sachin Wani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prateek Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prateek Sharma.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pondugula, K., Wani, S. & Sharma, P. Barrett’s esophagus and esophageal adenocarcinoma in adults: Long-term GERD or something else?. Curr Gastroenterol Rep 9, 468–474 (2007). https://doi.org/10.1007/s11894-007-0061-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-007-0061-9

Keywords

Search

Navigation