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Pathophysiological mechanisms linking obesity and esophageal adenocarcinoma.
[esophageal adenocarcinoma]
In
recent
decades
there
has
been
a
dramatic
rise
in
the
incidence
of
esophageal
adenocarcinoma
(
EAC
)
in
the
developed
world
.
Over
approximately
the
same
period
there
has
also
been
an
increase
in
the
prevalence
of
obesity
.
Obesity
,
especially
visceral
obesity
,
is
an
important
independent
risk
factor
for
the
development
of
gastro-
esophageal
reflux
disease
,
Barrett
's
esophagus
and
EAC
.
Although
the
simplest
explanation
is
that
this
mediated
by
the
mechanical
effects
of
abdominal
obesity
promoting
gastro-
esophageal
reflux
,
the
epidemiological
data
suggest
that
the
EAC-promoting
effects
are
independent
of
reflux
.
Several
,
not
mutually
exclusive
,
mechanisms
have
been
implicated
,
which
may
have
different
effects
at
various
points
along
the
reflux-
Barrett
'
s-
cancer
pathway
.
These
mechanisms
include
a
reduction
in
the
prevalence
of
Helicobacter
pylori
infection
enhancing
gastric
acidity
and
possibly
appetite
by
increasing
gastric
ghrelin
secretion
,
induction
of
both
low
-grade
systemic
inflammation
by
factors
secreted
by
adipose
tissue
and
the
metabolic
syndrome
with
insulin
-resistance
.
Obesity
is
associated
with
enhanced
secretion
of
leptin
and
decreased
secretion
of
adiponectin
from
adipose
tissue
and
both
increased
leptin
and
decreased
adiponectin
have
been
shown
to
be
independent
risk
factors
for
progression
to
EAC
.
Leptin
and
adiponectin
have
a
set
of
mutually
antagonistic
actions
on
Barrett
's
cells
which
appear
to
influence
the
progression
of
malignant
behaviour
.
At
present
no
drugs
are
of
proven
benefit
to
prevent
obesity
associated
EAC
.
Roux-en-
Y
reconstruction
is
the
preferred
bariatric
surgical
option
for
weight
loss
in
patients
with
reflux
.
Statins
and
aspirin
may
have
chemopreventative
effects
and
are
indicated
for
their
circulatory
benefits
.
Diseases
Validation
Diseases presenting
"cancer"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
alpha-thalassemia
benign recurrent intrahepatic cholestasis
cadasil
canavan disease
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cowden syndrome
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
hirschsprung disease
hodgkin lymphoma, classical
inclusion body myositis
junctional epidermolysis bullosa
kabuki syndrome
kallmann syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
monosomy 21
neuralgic amyotrophy
oculocutaneous albinism
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
pendred syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
werner syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated