Does Estrogen Contribute to the Esophageal Barrier Function in Women?
Abstract
Esophageal adenocarcinoma (EAC) develops as a series on the gastroesophageal reflux disease (GERD) spectrum, progressing from reflux esophagitis to Barrett’s esophagus and finally EAC. EAC has received intense focus for decades, especially in Western countries, where the incidence of EAC been increasing since the 1970s. However, in Asian countries, there has been no definite increasing trend with regard to EAC studies, with the proportion of EAC accounting for only a small percentage of total esophageal cancer cases. However, a very recent study from Japan indicated that the incidence of EAC has started to increase in Japan, due at least in part to a decreasing trend in the Helicobacter pylori infection rate in the general Japanese population, which is lagging 50 years behind Western countries. One prominent characteristic of EAC is its overwhelming male predominance, as described in a recent review. Furthermore, such male predominance is already initiated at the initial stage of the GERD spectrum, e.g., reflux esophagitis, although the tendency is amplified as the disease spectrum progresses. Hence, understanding the mechanism underlying the male predominance of reflux esophagitis may be important not only for the treatment of reflux esophagitis, but also for the prevention of the most advanced stage of GERD, EAC. A recent animal model study showed that the female hormone estrogen plays an important role in protecting the esophageal tissue from refluxed liminal noxious…
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