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We congratulate Zagari et al on their recent paper (Gut 2008;57:1354–9) in which they report the prevalence of gastroesophageal reflux disease and Barrett’s oesophagus in the Italian population. Such population-based studies are very rare and very valuable.
It is well established that oesophageal adenocarcinoma and Barrett’s oesophagus, complications of severe reflux disease, are much more common in males than females. Our own paper recently published in Gut demonstrated that this gender phenomenon is due to a 17 year lag in the age-specific incidence rate of the cancer in females versus males.1 A 20 year lag in the development of Barrett’s oesophagus has also been demonstrated in females by van Blankenstein et al.2 At present, it is unclear whether the marked gender phenomenon evident in oesophageal adenocarcinoma and Barrett’s oesophagus is due to males having more acid reflux or males showing a different mucosal response to acid reflux than females.
Hiatus hernia is a major cause of severe reflux and strongly associated with Barrett’s oesophagus, as indicated by Zagari et al and Gordon et al.3 Reliable information on the prevalence of hiatus hernia in males versus females and, in particular, whether females show a lag in age-specific incidence would be invaluable in further unravelling the role of gender in oesophageal adenocarcinoma. Unfortunately, the few previous studies of the estimated incidence of hiatus hernia in males and females did not provide age-specific incidences.4 5 The study by Zagari et al recently published in Gut would appear to have such information available, though not presented in the manuscript.
We would be most grateful if the authors would present the data on the age-specific incidence of hiatus hernia in males and females in their population. Information on the size of hiatus hernia in males and females would also be helpful if available.
Competing interests: None.
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