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The Burning Issue of Chronic Gastroesophageal Reflux
The incidence of esophageal adenocarcinoma, especially among white men, has increased steeply in the past two decades in the United States and several western European countries. Previously, fewer than 15% of all esophageal cancers were adenocarcinomas, but by 1994, nearly 60% were of this type (1). The Surveillance, Epidemiology, and End Results registry noted a more than 100% increase in the incidence of this tumor from 1976 to 1987 (2). Furthermore, the National Cancer Institute has reported a dismal overall 5-year survival rate of 11% for this disease (3).
Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders in the world. Recent population-based studies have estimated that 7% of persons in the United States experience heartburn daily, 20% experience it monthly, and 59% experience it intermittently (4, 5). The economic burden and negative effects on health-related quality of life are substantial (6, 7). Chronic GERD is also the primary cause of Barrett esophagus, a condition in which the normal stratified squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium (8). The concern about this metaplasia stems from its concordant malignant potential. The presence of Barrett esophagus is associated with a risk for esophageal adenocarcinoma that is 30 to 125 times that in the general population (9-11).
Previously, data demonstrating a direct association between GERD and risk for adenocarcinoma of the esophagus and gastric cardia were limited (12). …
