Metabolic syndrome and esophageal adenocarcinoma

I had the distinct pleasure of attending the American Society of Clinical Oncology Gastrointestinal Cancers Symposium in warm, sunny Orlando in January (oh, so warm). Several abstracts were of interest to me. I am starting here with a discussion about one of them.

A group from Ireland, at St. James' Hospital in Dublin, presented interesting data on a possible association between long segment Barrett's, metabolic syndrome and central obesity. Briefly, this was a case-control study, looking at those patients with Barrett's esophagus (BE) and a comparison cohort of patients who had gastroesophageal reflux disease (GERD) without BE. Patients were selected from a database, and then had several tests of anthropometry, as well as markers of their nutritional and inflammatory state. The purpose of this was to screen all these patients for metabolic syndrome and to look for relevant cytokines. In the end, 46% of patients with BE had metabolic syndrome vs. 32% of those with GERD (P=.04), although equal numbers were overweight or obese. Having long segment BE was strongly predictive of metabolic syndrome, compared to short segment BE (60% vs. 23.8%, P=.007).

As I am sure you are aware, the rates of esophageal adenocarcinoma are rising at alarming rates, in parallel with the rise in obesity in the United States. (The link shows the change in rates of obesity over the last few decades in a slide show which I think is particularly illustrative [and equally as alarming] and one which you may like to keep for your teaching files). Although the risk factor for the rise in esophageal adenocarcinoma has not been clearly defined, the link between obesity and esophageal cancer is becoming more compelling. We already know that obesity is linked with higher death rates among patients already diagnosed with esophageal cancer, and it is linked with development of other cancers (endometrial, breast, colon) but perhaps there is a key link between either obesity or, more importantly I suspect, metabolic syndrome, and the development of esophageal cancer. As a GI oncologist, I feel the rising numbers of esophageal cancers are concerning enough that more of an effort should be put towards etiology and prevention, as these researchers are doing.