Relationships clarified among gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma
Relationships among gastroesophageal reflux
disease, Barrett’s esophagus, and esophageal adenocarcinoma have
been somewhat clarified, according to a pair of presentations at
the annual Digestive Disease Week.
According to G. Richard Locke III, MD, and
Yvonne Romero, MD, Mayo Clinic gastroenterologists and presenters
of the two studies, the incidence of esophageal cancer is increasing
at what has been called an “epidemic” rate, but the cause for the
increase is uncertain.
In the first research project, the American
team studied 186 cases of esophageal and stomach adenocarcinoma
and found a significant association between esophageal cancer and
gastroesophageal reflux disease.
“But only about 5 percent of individuals who experience acid reflux
will develop Barrett’s esophagus,” said Romero. “And once Barrett’s
esophagus is diagnosed, patients have a 30- to 125-fold increased
risk of developing esophageal cancer.”
“Acid reflux is such a common problem that
it is unrealistic to perform an endoscopic examination on everyone
who experiences it,” added Locke. “Thus, in order to learn what’s
causing this increase in esophageal cancer, we first need to know
what’s causing Barrett’s esophagus and whether there are any genetic
risks for which acid reflux patients could be screened.”
A second study, led by Romero, examined that
question. Her team discovered strong evidence for susceptibility
genes in familial Barrett’s esophagus and esophageal adenocarcinoma.
The genetic linkage analysis was performed on 278 people in 31 families
with two or more members affected by Barrett’s esophagus, with or
without esophageal cancer.
“Our research found areas on a chromosome
that appear to be important for Barrett’s esophagus and esophageal
cancer -- so we’re on the right path,” said Romero. “Our next step
is to look at 94 additional families to identify the particular
genes associated with these disorders. Eventually, we’d like to
develop a blood test for Barrett’s esophagus to identify who has
this precancerous lining early in their disease course, to ultimately
prevent it from escalating into esophageal cancer.”
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