Barrett's esophagus as a marker for increased risk for esophageal cancer and cardiorespiratory disease

Abstract

We read with interest the article by Caygill et al. [1], titled “Mortality in Barrett’s esophagus: three decades of experience at a single center,” published in a recent issue of Endoscopy. Barrett’s esophagus results from gastroesophageal reflux and is predisposed to progress to esophageal adenocarcinoma via a sequence involving low grade and high grade dysplasia [2]. Caygill et al. [1] compared mortality, from 1978 to 2009, among persons with Barrett’s esophagus against that of the general population. Most importantly, the authors found that esophageal adenocarcinoma-related mortality of those with Barrett’s esophagus was 25-fold greater (annual cancer risk 0.43 %), compared with that of the general population and showed a male predominance. Furthermore, the majority of those with Barrett’s esophagus died from noncancer causes (cardiorespiratory). There was no difference regarding deaths due to nonesophageal cancers (colorectal etc.). The question remains of whether the data from the study contribute to more adequately characterize those who would profit from removal of Barrett’s esophagus before the development of dysplasia and cancer.