The direct relation between reflux and adenocarcinoma of the oesophagus has recently been addressed in several well designed population based epidemiological studies, using different study designs.^1–5 The studies are all in agreement that reflux is associated with an increased risk of oesophageal adenocarcinoma in a seemingly dose dependent manner.^1–5

The specific role of Barrett’s oesophagus for this association was not addressed in these studies but the presence of Barrett’s oesophagus has been regarded as a potential link in the causal pathway. More speculatively, based on an interpretation of the results from a large population based study in Sweden, we hypothesised that the relation between reflux and oesophageal adenocarcinoma might be independent of Barrett’s oesophagus.² This hypothesis was based on two …