A review of the epidemiology of Barrett's oesophagus and oesophageal adenocarcinoma

Abstract

While the incidence rates of many cancers have decreased in past decades, the incidence of oesophageal adenocarcinoma continues to increase. The only known precursor for oesophageal adenocarcinoma is Barrett’s oesophagus. Studies conducted have identified white race, male sex, GORD, cigarette smoking, obesity, and the absence of Helicobacter pylori status as risk factors for oesophageal adenocarcinoma. Other potential associations include dietary factors and the absence of non-steroidal anti-inflammatory drug use. Many individual studies have been limited by sample size and several meta-analyses have pooled data from studies to address this limitation. In this review we present a synthesis of these studies and summarize current knowledge of risk factors for both oesophageal adenocarcinoma and Barrett’s oesophagus.

Polymorphisms in genes in the androgen pathway and risk of Barrett's esophagus and esophageal adenocarcinoma

“…The sex differences in associations are not likely to be explained by sex difference in the exposure to environmental risk factors, that is, reflux, obesity and tobacco smoking, since the strengths of associations with EAC and BE are similar in men and women. 5,6 Regarding the association with BMI, it has been argued that abdominal adiposity, the typical male fat distribution, may contribute to the male predominance of EAC, since abdominal obesity is associated with an elevated risk of EAC independent of BMI. 22,31 However, a stratified analysis by BMI found no evidence of an increased male predominance among overweight individuals compared with lean, which argue against abdominal obesity as a factor contributing to the male predominance.…”

“…Understanding the basis for the male predominance in these conditions could bring new etiologic insights . Gastroesophageal reflux disease, obesity and tobacco smoking are the main known risk factors, but they do not entirely explain the current male predominance in EAC or BE in western countries . Emerging evidence suggests that genetic factors may contribute to the etiology of BE and EAC, but these factors have not been investigated with respect to sex‐specific differences.…”

“…1 Gastroesophageal reflux disease, obesity and tobacco smoking are the main known risk factors, 3,4 but they do not entirely explain the current male predominance in EAC or BE in western countries. 5,6 Emerging evidence suggests that genetic factors may contribute to the etiology of BE and EAC, 7-11 but these factors have not been investigated with respect to sex-specific differences. It has been hypothesized that sex hormones are involved in the male predominance.…”

Letter: future directions for epidemiological studies of Barrett's oesophagus

“…[1][2][3][4] Other factors include male gender, Caucasian race, advanced age, the presence of a hiatal hernia, and the presence and duration of heartburn and related gastro-oesophageal reflux (GER) symptoms. [5][6][7] A genetic predisposition for developing BO is also likely. 8 We also now know that patients with long segment BO (segment lengths ≥3 cm) have an increased risk for oesophageal adenocarcinoma.…”

Dietary fruit, vegetable, fat and red and processed meat intakes and Barrett’s esophagus risk: a systematic review and meta-analysis

“…Barrett’s esophagus (BE) is considered to be the strongest risk factor1 and the only known precursor for esophageal adenocarcinoma (EAC), with a thirty- to forty-fold increased risk23. EAC is one of the most lethal malignancies in the Western world, with a rapidly rising incidence14.…”