Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2005; 11(46): 7290-7295
Published online Dec 14, 2005. doi: 10.3748/wjg.v11.i46.7290
Have patients with esophagitis got an increased risk of adenocarcinoma? Results from a population-based study
Seamus J Murphy, Lesley A Anderson, Brian T Johnston, Deirdre A Fitzpatrick, Peter RG Watson, Pauline Monaghan, Liam J Murray
Seamus J Murphy, BSc MB BCh MRCP, Research Registrar in Gastroenterology, Northern Ireland Cancer Registry (NICR), Northern Ireland
Lesley A Anderson, PhD, Research assistant, NICR, Northern Ireland
Brian T Johnston, MD MRCP, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland
Peter RG Watson, MD FRCP, Consultant Gastroenterologists, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland
Deirdre A Fitzpatrick, Pauline Monaghan, Biostatisticians, NICR, Northern Ireland
Liam J Murray, MB, MFPHM, Consultant/Senior lecturer in Epidemiology, Department of Epidemiology and Public Health, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland
Author contributions: All authors contributed equally to the work.
Supported by The establishment of the NI Barrett’s Register was assisted by a grant from the Ulster Cancer Foundation
Correspondence to: Dr Seamus J Murphy, Northern Ireland Cancer Registry, Department of Epidemiology and Public Health, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland. s.murphy@qub.ac.uk
Telephone: +28-90240503 Fax: +28-90248017
Received: January 15, 2005
Revised: January 23, 2005
Accepted: January 26, 2005
Published online: December 14, 2005
Abstract

AIM: To examine an increased risk of esophageal adenocarcinoma is restricted to patients who develop Barrett’s esophagus or whether esophagitis per se is a risk factor for adenocarcinoma.

METHODS: A population-based cohort of patients with histological evidence of esophagitis without Barrett’s esophagus was constructed using electronic pathology reports relating to all esophageal biopsies in Northern Ireland between 1993 and 1996. Person-years of follow-up and incident cases of esophageal cancer were calculated by linking the cohort to death files and the Northern Ireland Cancer Registry records. Standardized incidence ratios (SIR) were calculated for esophageal cancers (adenocarcinoma, squamous cell carcinoma (SCC), and histologically unspecified cancers).

RESULTS: A total of 2 013 patients in the cohort provided 13 559 patient-years of follow-up (mean follow-up 6.7 years). None of the patients developed adenocarcinoma. Three patients developed SCC, and six developed histologically unspecified cancers. The SIR for all esophageal cancers and for SCC were 2.73 (95%CI 1.25-5.19) and 2.93 (95%CI 0.61-8.59), respectively. In a sensitivity analysis in which all unspecified esophageal cancers were treated as adenocarcinomas, the SIR for adenocarcinoma was 2.64 (0.97-5.75).

CONCLUSION: The risk of adenocarcinoma is not elevated in patients with histological evidence of esophagitis without Barrett’s esophagus; however, these patients may have a moderately increased risk of SCC. Further studies are required to confirm these findings, which suggest that Barrett’s esophagus, not esophagitis, is the key precursor lesion in the development of adenocarcinoma.

Keywords: Barrett’s esophagus; Esophageal adenocarcinoma; Esophageal squamous cell carcinoma; Esophagitis; Population-based study