Obesity in Relation to Risk of Esophageal Adenocarcinoma and Barrett’s Esophagus

The incidence of esophageal adenocarcinoma has increased rapidly in the USA and other western populations. Barrett’s esophagus, a metaplastic change in the distal esophagus, is the only known precursor for esophageal adenocarcinoma. Epidemiological studies strongly implicate gastroesophageal reflux disease symptoms and obesity as the primary causal factors for esophageal adenocarcinoma and Barrett’s esophagus. Recent studies suggest that abdominal obesity, rather than overall obesity, is associated with esophageal adenocarcinoma and Barrett’s esophagus and that these associations are not entirely explained by gastroesophageal reflux disease symptoms. Evidence from these studies indicates that abdominal obesity has both mechanical (for example, via disruption of the gastroesophageal junction and resulting gastroesophageal reflux symptoms) and nonmechanical metabolic and inflammatory effects on esophageal adenocarcinoma and Barrett’s esophagus. Overall, the current body of literature provides some insights into the potential biological mechanisms linking abdominal obesity with esophageal adenocarcinoma and Barrett’s esophagus.