3to dysplasia and invasive adenocarcinoma. Increased body weight
and obesity may increase intra-abdominal pressure resulting in
GORD. Nevertheless, increased body weight and obesity are asso-
ciated with increased risk of adenocarcinoma in this region inde-
pendent of GORD. In view of the increasing incidence of
esophageal adenocarcinoma, it is important that pay more atten-
tion to the prevention of these predisposing lesions. However, the
rate of progression towards adenocarcinoma is very small.
The other related factor is Helicobacter pylori (Fig. 2 ) [ 5 ].
Helicobacter pylori infection is associated with reduction of
amount of gastric acid and resulting in lower frequency of GORD
and hence lower prevalence of adenocarcinoma in this region.
There are other factors contributed to esophageal adenocarci-
noma. Tobacco smoking is associated with increased risk of having
adenocarcinoma of esophagus as well as adenocarcinoma of esoph-
agogastric junction [ 5 ]. In addition, dietary factors contributed to
the risk of esophageal adenocarcinoma. The consumption of meat
(particularly red meat) is provocative whereas fruit, vegetables,
fiber, foliates, beta-carotene, and vitamin C intakes are protective
against esophageal adenocarcinoma [ 5 ]. Furthermore, statins
(which are prescription medicines, used to lower cholesterol) users
appear to have a decreased risk of progression from Barrett esopha-
gus to adenocarcinoma [ 6 , 7 ]. Lately, in the genome-wide studies,
there are susceptibility loci noted which predispose to Barrett
esophagus could suggest the presence of genetic risk factors for
esophageal adenocarcinoma [ 8 ].
Esophageal adenocarcinoma or esophagogastric junction adeno-
carcinoma typically occurs in the lower esophagus or around the
esophagogastric junction (Fig. 3 ). Rarely, esophageal adenocarci-
noma could occur in the middle or proximal third of the esophagus
(Fig. 4 ). It may originate from congenital presence of heterotopic
columnar epithelium or glands in the esophagus [ 9 ]. The latter may
account for some subtypes of esophageal adenocarcinoma.3 Clinical Features and Management
The majority of the patients with esophageal adenocarcinoma pre-
sented in the late adult life mainly in the sixth decade of life. There
is a strong male preponderance.
Patients with esophageal adenocarcinoma could be asymptom-
atic. Many of the patients could be on clinical follow-up for Barrett
esophagus and thus may carry the symptoms of GORD. The other
patients may present symptoms related to difficulty in swallowing
as well as weight loss.
The diagnosis of the esophageal adenocarcinoma is by
using endoscopic biopsy of esophageal lesion with pathological
examination. Radiological examinations are needed for pre-Updates of Esophageal Adenocarcinoma