Reflux esophagitis and carcinoma.

Early detection of a malignancy in reflux esophagitis should permit an effective surgical action if a causal time relation between reflux, esophagitis and carcinoma exists. In the medical literature on tumors of the esophagus associated with reflux esophagitis, it has been reported that they are adenocarcinomas in most instances. Squamous carcinomas are seldom mentioned. In a population of patients with five squamous carcinomas and 13 adenocarcinomas associated with reflux, three squamous carcinomas had developed on stage III or on a stenotic esophagitis and two squamous carcinomas were at the upper limit of a Barrett's esophagus. The 13 adenocarcinomas were associated with a Barrett's esophagus. No carcinoma was found to be associated with a low grade esophagitis. During the same time period, 224 patients were operated upon for a serious documented esophagitis (stage III, stenotic, Barrett's esophagus), including the 18 patients with carcinoma. Five hundred and thirty-four patients were operated upon for a lower grade esophagitis, with no associated carcinoma and 592 patients were operated upon for carcinoma of the esophagus. The five squamous carcinomas associated with reflux were resected and classified T1 N0. The 13 adenocarcinomas associated with reflux were resected and classified T1 N0 M0 (two patients), T2 N0 M0 (two), T3 N0 M0 (five), T3 N1 M0 (one patient), T3 N2 M0 (one) and T3 N3 M0 (two patients). Four patients with squamous carcinomas were alive after two, six, nine and 15 years. Eight patients with adenocarcinomas were alive after two years (one patient), three years (two patients), four years (three), five years (one patient) and seven years (one). Three carcinomas were diagnosed by routine endoscopy. The mean age of the patients with carcinoma associated with reflux was older than in the general carcinoma series, the relative number of females was higher and the use of alcohol and tobacco was not as frequent, but the differences were not significant. In squamous and columnar carcinomas, a long history was significant (p less than 0.001); in Barrett's esophagus, loss of weight (p less than 0.01), intestinal epithelium (p less than 0.001) and dysplasia (p less than 0.01) were also significant. In one patient, carcinoma was discovered during the follow-up evaluation of an antireflux procedure for Barrett's esophagus.(ABSTRACT TRUNCATED AT 400 WORDS)