Opportunities for preventing esophageal adenocarcinoma

• Esophageal adenocarcinoma is rapidly increasing in incidence in many Western societies, requires demanding treatment and is associated with a poor prognosis, therefore preventive measures are highly warranted. To assess the opportunities for prevention, we reviewed the available literature and identified seven main potentially preventive targets. Preventive effects were found based on medium level observational evidence following treatment of gastroesophageal reflux disease (both using medication and surgery) and tobacco smoking cessation, which should be clinically recommended among exposed patients. Non-steroidal anti-inflammatory drugs appears to prevent esophageal adenocarcinoma, and the limited existing data also indicates a protective effect of medication with statins or hormone replacement therapy in women, but current evidence is insufficient to guide clinical decision-making regarding these drugs. The evidence is presently insufficient to assess the potentially preventive role of weight loss. Whether avoidance of eradication of Helicobacter pylori prevents esophageal adenocarcinoma is not studied, but there is no evidence that such eradication increases symptoms of gastro- esophageal reflux or prevalence of erosive esophagitis. The introduction of preventive actions should be tailored towards high-risk individuals, i.e. older men with obesity and gastroesophageal reflux disease and individuals with Barrett’s esophagus rather than the population at large.

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