Waring Jp

Racial differences in the histology, location, and risk factors of esophageal cancer.

Although esophageal cancer is uncommon in the united states, its high mortality rate and recent increased incidence make it an important malignancy. Because there appears to be significant racial variation in the types of esophageal cancer, we examined a group of black patients with esophageal cancer and compared their risk factors, histology, and location with those of a cohort of white patients with esophageal cancer seen during the same period. We retrospectively reviewed patients with esophageal cancer seen at three major hospitals in Atlanta, Georgia from January 1990 to April 1996. Patients of races other than white or black were excluded from this study, the esophagus was separated into upper, middle, and lower thirds by defined criteria. Of the eligible 234 patients, 129 were black and 105 were white. In blacks with esophageal cancer, squamous cell cancer was the predominant type (92%), and adenocarcinoma was infrequent in whites, adenocarcinoma was more common than squamous cell cancer (66% vs. 32%). Although Barretts esophagus was distinctly uncommon, smoking and alcohol consumption were significantly more common in blacks. Only 43% of the patients with adenocarcinoma had evidence of barretts esophagus, all adenocarcinomas were located in the lower third of the esophagus. There appear to be significant racial differences in the types, risk factors, and location of esophageal cancer. Adenocarcinoma and Barretts esophagus are uncommon in blacks.

NSAIDs, aspirin, and esophageal strictures: are over-the-counter medications harmful to the esophagus?

There are several studies that suggest that aspirin (acetylsalicylic acid [ASA]) and nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with esophagitis or esophageal stricture formation. There are limited data on the potential of low-dose ASA and over-the-counter (OTC) NSAIDs to cause esophageal injury. The goal of this study was to determine whether there is an association between esophageal strictures and ASA/NSAID use, including low-dose ASA and OTC NSAIDs. A total of 79 consecutive patients (mean age, 52.8 years; 38 men, 41 women) referred for endoscopy from 4/1/96 to 11/15/96 for chronic gastroesophageal reflux disease symptoms were evaluated. Data collected include gender, race, and age, NSAID or ASA use, as well as an assessment of dysphagia, heartburn duration, and heartburn frequency. Patients taking NSAIDs or ASA at least twice a week were considered ASA/NSAID users. There were 46 patients without strictures and 33 patients with peptic strictures. Patients with strictures were older than patients without strictures (mean age, 58.7 versus 48.6 years; p < 0.01), had longer duration of heartburn symptoms (8.6 versus 6.4 years, p < 0.05), and were more likely to have mucosal injury (50% versus 26.1%). Stricture patients were more likely to use ASA/NSAIDs (63.6% versus 26.1%; p < 0.01). In particular, stricture patients were more likely to use low-dose ASA than patients without strictures (30.3% versus 2.2%; p < 0.01). Otherwise, there were no significant differences with regard to gender, race, or heartburn duration or frequency. Linear regression analysis showed that ASA/NSAID use had a greater influence on the incidence of peptic strictures than age. There is an association between esophageal stricture and ASA/NSAID use, which includes OTC NSAIDs and low-dose ASA.