The incidence of esophageal adenocarcinoma (EAC) arising from Barrett’s esophagus has increased by 350% since 1970. The prognosis for EAC is poor and the overall 5-year survival rate is less than 10%. At the time of presentation, at least half of all patients have advanced disease with no chance for cure.
Endoscopic screening for Barrett’s esophagus and EAC has been recommended for patients with classic and chronic symptoms of gastroesophageal reflux disease (GERD). Several retrospective studies have demonstrated an earlier stage of diagnosis and a marked improvement in survival of patients with cancers detected by routine endoscopic surveillance of Barrett’s esophagus. Despite these efforts, the majority of patients who develop EAC are unaware of the presence of Barrett’s esophagus prior to cancer diagnosis. In addition, a large proportion of these patients have never experienced symptoms of GERD. This finding reflects the inadequacy of using typical reflux symptoms as the “trigger” for screening endoscopy and highlights the need for improved screening criteria for Barrett’s esophagus and EAC. Some investigators have suggested that patients who develop Barrett’s esophagus may not have typical GERD symptoms and therefore are not selected for endoscopic screening. As a result, occult disease progression occurs and advanced cancer is present at the time of diagnosis.
Substantial published data support a causal relation between documented GERD and laryngopharyngeal reflux (LPR) symptoms. However, the prevalence of GERD related esophageal injury in patients with laryngopharyngeal symptoms is unknown. The aim of this investigation was to determine whether the presence of laryngopharyngeal symptoms is associated with an increased risk for the presence of EAC. This may provide insight required to improve risk stratification for EAC and potentially modify the inclusion criteria for routine Barrett’s esophagus screening.
Kevin M. Reavis, MD,* Cynthia D. Morris, PhD, MPH,† Deepak V. Gopal, MD, FRCP(C),‡ John G. Hunter, MD,* and Blair A. Jobe, MD*