Shaker Anisa
Swallowing and Esophageal Disorders Center, Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA.
Ann Esophagus. 2025 Jun 30;8. doi: 10.21037/aoe-24-46. Epub 2025 Jun 23.
Alcohol use accounts for significant morbidity and mortality globally. A wide range of esophageal disorders have been associated with alcohol consumption, most concerning of which is esophageal squamous cell cancer (ESCC). Alcohol use has also been associated with exacerbation of gastroesophageal reflux disease (GERD) symptoms. Despite being one of the first organs to encounter this toxic agent, the molecular effects of alcohol on the human esophagus and the mechanisms by which alcohol exerts its effects on esophageal motility and carcinogenesis remain incompletely defined. The objective of this narrative review is to provide an overview of the effect of alcohol and its toxic metabolite acetaldehyde on cellular signaling, the microbiome, and motility in the esophagus, along with a discussion on the possible mechanisms by which alcohol use increases risk for ESCC.
A literature search was performed using PubMed, Google Scholar, and Ovid MEDLINE for the period from inception to December 1, 2024. To identify all relevant literature, the following search terms were used: "Alcohol OR ethanol" AND "esophagus OR GERD OR gastroesophageal reflux OR reflux OR cancer OR EoE OR eosinophilic esophagitis OR signaling OR epithelium OR stroma OR fibrosis OR microbiome". Studies published in English with full available text were included.
This narrative review provides an overview of the effect of alcohol consumption on the human esophagus. The review highlights the dose-dependent risk of ESCC with alcohol use, with increasing risk with higher consumption; with evidence of increased risk even with the smallest amounts of alcohol consistent with the International Agency for Research on Cancer recognition of alcohol as a Group 1 carcinogen. The review also discusses the mechanisms of carcinogenesis, highlighting the role of acetaldehyde, as well as the non-malignant consequences of alcohol on the esophagus, including effects on cellular signaling, the microbiome, and gastro-esophageal reflux disease.
Alcohol consumption continues to exert morbidity and mortality worldwide. Increasing awareness of the multitude of established and potential effects on the human esophagus will allow for rationale supporting at the very least the moderation of alcohol consumption.
全球范围内，饮酒导致了显著的发病率和死亡率。多种食管疾病都与饮酒有关，其中最令人担忧的是食管鳞状细胞癌（ESCC）。饮酒还与胃食管反流病（GERD）症状加重有关。尽管食管是最早接触这种有毒物质的器官之一，但酒精对人体食管的分子影响以及酒精对食管动力和致癌作用的机制仍未完全明确。本叙述性综述的目的是概述酒精及其有毒代谢产物乙醛对食管细胞信号传导、微生物群和动力的影响，并讨论饮酒增加ESCC风险的可能机制。
使用PubMed、谷歌学术和Ovid MEDLINE进行文献检索，检索时间从数据库建立至2024年12月1日。为识别所有相关文献，使用了以下检索词：“酒精或乙醇”以及“食管或GERD或胃食管反流或反流或癌症或EoE或嗜酸性食管炎或信号传导或上皮或基质或纤维化或微生物群”。纳入发表于英文且有全文的研究。
本叙述性综述概述了饮酒对人体食管的影响。该综述强调了饮酒导致ESCC的剂量依赖性风险，饮酒量增加风险也随之增加；有证据表明，即使是与国际癌症研究机构将酒精认定为1类致癌物相符的最小饮酒量，风险也会增加。该综述还讨论了致癌机制，强调了乙醛的作用，以及酒精对食管的非恶性后果，包括对细胞信号传导、微生物群和胃食管反流病的影响。
饮酒在全球范围内持续导致发病和死亡。提高对酒精对人体食管已确定的多种影响和潜在影响的认识，将至少为支持适度饮酒提供合理依据。
