Obesity and esophageal cancer: GERD, Barrett´s esophagus, and molecular carcinogenic pathways

ABSTRACT

Introduction

Increases in the rates of esophageal adenocarcinoma (EAC) have paralleled rises in the prevalence of overweight and obesity. Despite not being fully understood, obesity-related EAC seems to have different carcinogenic pathways.

Areas covered

This comprehensive review will thoroughly evaluate the current literature, describing the underlying mechanisms that help understanding the strong association between obesity and esophageal cancer.

Expert commentary

The risk of esophageal cancer among obese individuals could be partially explained by several factors: high prevalence of GERD; linear association between central adiposity and Barrett´s esophagus development; low levels of adiponectin and high levels of leptin that alter cell proliferation processes; insulin-resistant state that creates a tumorigenesis environment; and changes in the esophageal microbiota due to unhealthy dietary habits that promote carcinogenesis. In addition, a large proportion of obese patients are undergoing sleeve gastrectomy which can worsen GERD or cause de novo reflux, esophagitis, and Barrett´s metaplasia.

KEYWORDS:

• Obesity
• esophageal cancer
• gastroesophageal reflux disease
• Barrett´s esophagus
• sleeve gastrectomy
• Roux-en-Y gastric bypass

Article Highlights

• Both obesity and esophageal adenocarcinoma prevalence have risen over the last decades.

• Obese individuals are likely to have GERD due to abnormal esophageal clearance, increased intra-abdominal pressure, presence of hiatal hernia, and unhealthy dietary habits.

• There is a linear association between central adiposity and Barrett´s esophagus.

• The characteristic hyperleptinaemia and hypoadiponectinaemia associated to obesity seem to contribute to the progression of several obesity-related cancers.

• Visceral adipose tissue leads to an insulin-resistant state that creates a tumorigenesis environment that promotes the development of esophageal adenocarcinoma.

• A large proportion of obese patients are undergoing sleeve gastrectomy which can worsen GERD or cause de novo reflux, esophagitis, and Barrett´s metaplasia.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.