Prediction of malignant potential in reflux disease

There is interest in noninvasive means of identifying reflux patients at increased risk of developing Barrett's esophagus and adenocarcinoma. In this issue, Gough et al. studied the prevalence of polymorphisms of cytokine genes in patients with uncomplicated esophagitis versus Barrett's/esophageal adenocarcinoma. They reported a difference between the groups with respect to the interleukin-1 receptor antagonist and interleukin-10 genes. However, the number of comparisons carried out mean that the association is not statistically significant and further studies will be required to confirm/refute the association. The genetic markers reported would unfortunately be of little value in predicting individual risk of esophageal adenocarcinoma as they are weak predictors and relatively rare within the esophagitis population. The findings of this study demonstrate the general principle that polymorphisms of individual genes are of limited value in identifying patients at risk of sporadic-types of cancer such as most cases of esophageal adenocarcinoma.