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Obesity and Barrett’s oesophagus: more than just reflux
  1. Julian A Abrams1,2
  1. 1
    Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA
  2. 2
    Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
  1. Correspondence to Dr Julian Abrams, 630 W 168th Street, Black 10-508, New York, NY 10032, USA; ja660{at}columbia.edu

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Numerous studies have demonstrated an association between obesity and an increased risk of various epithelial malignancies.1 The factors underlying these associations are probably complex, and may relate to chronic inflammation, hyperinsulinaemia and increased production of adipokines and other adipose-derived hormones.2 Obesity is also associated with an increased risk of gastro-oesophageal reflux disease (GORD), an established risk factor for oesophageal adenocarcinoma. It is widely accepted that GORD is associated with and probably directly contributes to the development of Barrett’s oesophagus, the precursor lesion for oesophageal adenocarcinoma. It is not clear, however, whether obesity alone, independent of GORD, also plays a role in this metaplastic transformation.

In the article by Jacobson et al (see page 1460), data prospectively collected from the Nurses’ Health Study cohort were examined to study the relationship between obesity and Barrett’s oesophagus in women.3 More than 15 000 women who underwent upper endoscopy were included in the study, and data were collected on self-reported height and weight as well as self-measured waist and hip circumference. Body mass index (BMI) ⩾30 was associated with a significantly increased odds of Barrett’s oesophagus, and this association persisted even when the analyses were restricted only to patients (cases and controls) with a history of GORD symptoms. Interestingly, neither the waist-to-hip ratio (WHR) nor the waist circumference was independently associated with Barrett’s oesophagus.

The authors used data from …

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