G&H What has recent research revealed about the rise in esophageal adenocarcinoma despite screening and surveillance for Barrett esophagus?
AC Esophageal adenocarcinoma (EAC) has been increasing for several decades, and no one understands exactly what changed in our environment to cause the rise. There are etiologies one can speculate on. Obesity has increased and along with it, gastroesophageal reflux disease (GERD) has increased, although neither risk factor can entirely explain the rise in incidence. Obesity and GERD are known independent risk factors for EAC, but the odds ratios would only explain a fraction of the increasing incidence. We do not know what in obesity causes Barrett esophagus or cancer. Diet and lifestyle may be part of it. Helicobacter pylori also protects against EAC. Eradication of H pylori or alterations in the human gut microbiome, where H pylori may just be a surrogate marker for another microbe, may be contributing to the rise in cancer. However, the environmental change that has led to this dramatic increase has not been identified.