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Barrett’s esophagus is characterized by metaplastic columnar epithelium in the distal esophagus. Esophageal adenocarcinoma can occur from dysplastic progression of Barrett’s esophagus.
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There is evidence that Barrett’s esophagus is more strongly related to central adiposity and waist-to-hip-ratio than overall obesity.
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Both obesity and the incidence of esophageal adenocarcinoma have increased significantly in the past three decades. Numerous studies have shown an association between obesity and
Is Obesity Associated with Barrett’s Esophagus and Esophageal Adenocarcinoma?
Section snippets
Key points
Barrett’s esophagus
Barrett’s esophagus is characterized by the replacement of squamous mucosa in the distal esophagus with metaplastic columnar epithelium as a result of chronic exposure of the distal esophagus to acidic gastric contents. Barrett’s esophagus can progress to low-grade dysplasia and high-grade dysplasia before ultimately terminating in EAC seen in Fig. 1. However, this pathway is not obligatory.4 Nevertheless, Barrett’s esophagus is associated with a 40-fold increase in the risk of EAC over the
Obesity and Barrett’s esophagus
Epidemiologic studies have revealed that the mean body mass index (BMI) is higher in patients with Barrett’s esophagus than the general population.6 Follow-up cross-sectional studies have demonstrated a significant relationship between Barrett’s esophagus and obesity.7 Additionally, it has been shown that increased BMI is associated more strongly with long-segment than short-segment Barrett’s esophagus.6 Therefore, obesity may be a risk factor for Barrett’s metaplasia and a possible factor in
Obesity and esophageal adenocarcinoma
The incidence of EAC has increased a staggering 600% over the last 30 years.11 At the same time, the worldwide prevalence of obesity has also increased. Fig. 3 shows the trends in incidence of EAC and in obesity prevalence. Given the increase in obesity and EAC in the past several decades, numerous studies have examined this relationship. A study based on registry data examined the increase in EAC in the United States, Spain, and the Netherlands. There was a significant increase in all three
Mechanism of carcinogenesis
A logical mechanism for the relationship between obesity, Barrett’s esophagus, and EAC is the pathway of GERD. Obesity causes increased intra-abdominal pressure and an increased risk of hiatal hernia. When pressure and distention in the stomach increase, transient lower esophageal sphincter relaxations are triggered; this facilities the retrograde movement of gastric contents into the distal esophagus. As seen in Fig. 4, increased intragastric pressure and decreased intraesophageal pressure can
Dietary impact
There have been many studies on the role of diet in Barrett’s esophagus and EAC. Dietary nitrites have been identified and publicized as a potential risk factor for many types of malignancy.24 They are found naturally in high quantities in green leafy vegetables and are often added to processed meats. Nitrites are converted into nitrous oxide in the presence of gastric acid, and in the epithelium of esophagus can lead to the production of N-nitroso products, which are potential carcinogens.
Summary
Barrett’s esophagus, EAC, and obesity have all increased dramatically over the past several decades. Based on current data, generalized and central obesity are risk factors for Barrett’s esophagus and general obesity is a risk factor for EAC. BMI is not applicable to every patient and abdominal obesity specifically may play a more important role. Given that men have a higher prevalence of central obesity than women; this finding may account for the gender disproportionate incidence of Barrett’s
References (30)
- et al.
Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies
Lancet
(2008) Barrett's oesophagus: frequency and prediction of dysplasia and cancer
Best Pract Res Clin Gastroenterol
(2015)- et al.
Abdominal obesity and body mass index as risk factors for Barrett's esophagus
Gastroenterology
(2007) - et al.
Central adiposity and risk of Barrett's esophagus
Gastroenterology
(2007) - et al.
Waist-to-hip ratio, but not body mass index, is associated with an increased risk of Barrett's esophagus in white men
Clin Gastroenterol Hepatol
(2013) - et al.
A prospective study of BMI and risk of oesophageal and gastric adenocarcinoma
Eur J Cancer
(2008) - et al.
Role of obesity in Barrett’s esophagus and cancer
Surg Oncol Clin N Am
(2009) - et al.
Association between markers of obesity and progression from Barrett’s esophagus to esophageal adenocarcinoma
Clin Gastroenterol Hepatol
(2013) - et al.
Effect of roux-en-y gastric bypass in obese patients with Barrett’s esophagus: attempts to eliminate duodenogastric reflux
Surg Obes Relat Dis
(2008) - et al.
Dietary N-nitroso compounds, endogenous nitrosation, and the risk of esophageal and gastric cancer subtypes in the Netherlands cohort study
Am J Clin Nutr
(2013)
Fruit and vegetable intake and risk of cancer: a prospective cohort study
Am J Clin Nutr
Comparing trends in esophageal adenocarcinoma incidence and lifestyle factors between the United States, Spain, and the Netherlands
Am J Gastroenterol
Gastroesophageal reflux disease, proton-pump inhibitor use and Barrett's esophagus in esophageal adenocarcinoma: trends revisited
Surgery
The relationship between length of Barrett's oesophagus mucosa and body mass index
Aliment Pharmacol Ther
The association of body mass index with Barrett's oesophagus
Aliment Pharmacol Ther
Cited by (8)
Sex-Specific Genetic Associations for Barrett's Esophagus and Esophageal Adenocarcinoma
2020, GastroenterologyGastro-esophageal reflux disease in primary care practice: a narrative review
2023, Annals of EsophagusThe Impact of Obesity on Mortality and Other Outcomes in Patients with Nonvariceal Upper Gastrointestinal Hemorrhage in the United States
2019, Journal of Clinical Gastroenterology
Disclosure Statement: The author has nothing to disclose.