Have patients with esophagitis got an increased risk of adenocarcinoma? Results from a population-based study.
OBJECTIVE
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).


CONCLUSIONS
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.
Murphy
Seamus J
SJ
Department of Epidemiology and Public Health, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland. s.murphy@qub.ac.uk
Anderson
Lesley A
LA
Johnston
Brian T
BT
Fitzpatrick
Deirdre A
DA
Watson
Peter Rg
PR
Monaghan
Pauline
P
Murray
Liam J
LJ
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000453:epidemiology; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D004941:Esophagitis / Q000150:complications* / Q000453:epidemiology; D004942:Esophagitis, Peptic / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors