Search Annals: Advanced search

Rapid Responses to:

Reviews: Howard Hampel, Neena S. Abraham, and Hashem B. El-Serag Meta-Analysis: Obesity and the Risk for Gastroesophageal Reflux Disease and Its Complications Ann Intern Med 2005; 143: 199-211 [Abstract] [Full text] [PDF]

Send comment/rapid response letter

Electronic letters published:

Malnutrition and molecular basis of esophageal adenocarcinoma

Prasanta Padhan, INDIA.605006   (25 August 2005)

The Obese Refluxer- Nothing New Under the Sun

Douglas J Sprung, None   (15 August 2005)

Malnutrition and molecular basis of esophageal adenocarcinoma 25 August 2005
Prasanta Padhan, MD SENIOR RESIDENT IN INTERNAL MEDICINE,JIPMER,PONDICHERRY., INDIA.605006 Send rapid response to journal: Re: Malnutrition and molecular basis of esophageal adenocarcinoma prasanta.padhan{at}gmail.com Prasanta Padhan, et al.	Malnutrition either as over and undernutrition can result in deficiency of trace elements such as zinc which can lead to Cyclin D1 overexpression and p53 deficiency,which increases cell proliferation.Further zinc deficiency has been found to dysregulate p16ink4a-cyclin D1/Cdk4-Rb pathway,thereby promoting esophageal tumors.Many other genes and gene products such as TGF-á,EGF,COX- 2,FAS,VEGF,Telomerase are also commonly linked to both esophageal and colonic adenocarcinoma in obese individuals.Whether these can be targeted as a therapeutic option needs further research and large scale studies.Role of aspirin as COX-2 inhibitor in regulating apoptosis appears theoritically as a promising drug as in prevention of colonic adenocarcinoma in patients with familial adenomatous polyposis. Conflict of Interest: None declared
The Obese Refluxer- Nothing New Under the Sun 15 August 2005
Douglas J Sprung, MD, FACP, FACG Florida Hospital, Orlando,Fl, None Send rapid response to journal: Re: The Obese Refluxer- Nothing New Under the Sun dougjay54{at}hotmail.com Douglas J Sprung, et al.	The meta-analysis by Hampel et al ( 1) was immensely impressive. Yet, it has amazed me over the past 3 decades, how much energy has gone into the debate as to whether or not obesity causes gastroesophageal reflux. As a medical student at Duke in the 1970's I learned that obesity was commonly associated with reflux symptoms by spending time at the Rice Diet program in Durham,NC. Dr Kempner would bring over one obese patient after another and he would discuss their symptoms and medical issues, including hypertension, diabetes,heart failure,gallstones,arthritis and reflux symptoms. After a few weeks on the program,without any antacids or proton- pump inhibitors,the reflux symptoms were resolved in most of the patients ,as their oral intake and weight had dramatically reduced. Those observations were published in the 1960's, and quite frankly the conclusions drawn from this extensive meta-analysis could have been garnered by simply speaking to any of the successful dieter's at the Rice House or other diet centers around the country. It is an academic shame that so much time,effort and grant money had to be spent to this end. As far as Barrett's esophagus(BE) and adenocarcinoma go, we have not found a significant association with obesity in our community private practice. 1/9 patients with incident adenocarcinoma within BE was obese. Very few patients with BE (long segment) were obese.Whereas obesity is correlated with reflux symptoms, Barrett's esophagus and its complications were not in our community. 1.Hampel H,Abraham N,El-Serag HB. Meta-Analysis: Obesity and the Risk for Gastroesophageal Reflux Disease and its Complications. Ann INtern Med. 2005;143:199-211. 2.Sprung DJ,Sprung GM. Barrett's Esophagus In Our Community Over the Past 12 Years. Amer Journal Gastro. Vol 98,No 9,supp 2003; S-1. Conflict of Interest: None declared