Diet, reflux and the development of squamous cell carcinoma of the oesophagus in Africa

Background Squamous cancer of the oesophagus has reached epidemic proportions in Africa in the past few decades. There are many known associations but as yet no well established theory of causation. Methods Relevant literature was found by manual review of appropriate journals and literature, Medline searches and cross‐referencing. Published theories of causation of endemic cancer of the oesophagus were assessed in the light of available evidence. A hypothesis based on that evidence was formulated. Results and conclusion A predominantly maize‐based diet is high in linoleic acid, a precursor for gastric prostaglandin synthesis. In combination with low intake of other fatty acids and riboflavin, high levels of prostaglandin E2 are produced in gastric mucosa, leading to reduced gastric acid secretion, relaxation of the pylorus and a reduction in lower oesophageal sphincter pressure. These events result in combined reflux of duodenal and gastric juices low in acidity into the oesophagus. Resulting dysplasia strongly predisposes to local squamous carcinogenesis. This is now a fertile area for research, which may open the way for preventive action. © 1998 British Journal of Surgery Society Ltd