Yang Liying, Chaudhary Noami, Baghdadi Jonathan, Pei Zhiheng
From the *Department of Medicine, New York University School of Medicine, New York, NY; and †Department of Veterans Affairs New York Harbor Healthcare System, New York, NY 10010; Departments of Medicine and Pathology, New York University School of Medicine, New York, NY.
Cancer J. 2014 May-Jun;20(3):207-10. doi: 10.1097/PPO.0000000000000044.
The incidence of esophageal adenocarcinoma has increased dramatically in the United States and Europe since the 1970s without apparent cause. Although specific host factors can affect risk of disease, such a rapid increase in incidence must be predominantly environmental. In the stomach, infection with Helicobacter pylori has been linked to chronic atrophic gastritis, an inflammatory precursor of gastric adenocarcinoma. However, the role of H. pylori in the development of esophageal adenocarcinoma is not well established. Meanwhile, several studies have established that a complex microbiome in the distal esophagus might play a more direct role. Transformation of the microbiome in precursor states to esophageal adenocarcinoma-reflux esophagitis and Barrett metaplasia-from a predominance of gram-positive bacteria to mostly gram-negative bacteria raises the possibility that dysbiosis is contributing to pathogenesis. However, knowledge of the microbiome in esophageal adenocarcinoma itself is lacking. Microbiome studies open a new avenue to the understanding of the etiology and pathogenesis of reflux disorders.
自20世纪70年代以来，美国和欧洲的食管腺癌发病率急剧上升，原因不明。虽然特定的宿主因素会影响患病风险，但发病率如此迅速的上升主要必定是环境因素所致。在胃部，幽门螺杆菌感染与慢性萎缩性胃炎有关，而慢性萎缩性胃炎是胃腺癌的一种炎症前驱病变。然而，幽门螺杆菌在食管腺癌发生过程中的作用尚未明确。与此同时，多项研究证实，远端食管中的复杂微生物群可能发挥更直接的作用。从前体状态（反流性食管炎和巴雷特化生）到食管腺癌，微生物群从以革兰氏阳性菌为主转变为大多为革兰氏阴性菌，这增加了生态失调导致发病机制的可能性。然而，目前缺乏对食管腺癌本身微生物群的了解。微生物群研究为理解反流性疾病的病因和发病机制开辟了一条新途径。
