臨牀消化器内科 Vol.30 No.11(1-2)


特集名 消化器癌予防 up‒to‒date
題名 食道癌 (2) 飲酒・喫煙と食道癌
発刊年月 2015年 10月
著者 横山 顕 国立病院機構久里浜医療センター臨床研究部
【 要旨 】 食道癌は頭頸部癌と同時性・異時性に多発重複し,2大危険因子は飲酒・喫煙である.エタノールとアセトアルデヒドへの曝露量が増えるアルコール脱水素酵素1B(ADH1B)の低活性型とアルデヒド脱水素酵素2(ALDH2)のヘテロ欠損型は飲酒・喫煙との組み合わせで発癌リスクを著しく高める.食道多発ヨード不染帯,口蓋・食道メラノーシス,MCV増大,ビールコップ1杯で赤くなる体質が,現在または飲み始めた頃にあった人をフラッシャーとする簡易フラッシング質問紙法は高危険群の特定に役立つ.節酒,禁酒,禁煙,野菜・果物の摂取は食道癌リスクを低下させる.予防の新戦略となるADH1B/ALDH2遺伝子解析の普及が望まれる.
Theme Up‒to‒date of the Protection of Gastroenterological Cancers
Title High‒risk Groups and Preventive Strategy for Esophageal Cancer
Author Akira Yokoyama National Hospital Organization Kurihama Medical and Addiction Center
[ Summary ] Genetic polymorphisms of alcohol dehydrogenase‒1B (ADH1B) and aldehyde dehydrogenase‒2 (ALDH2) modulate exposure levels to ethanol/acetaldehyde. The combination of alcohol consumption, smoking, slow‒metabolizing ADH1B*1/*1, and inactive heterozygous ALDH2*1/*2 markedly increase the risk of developing esophageal cancer, head and neck cancer, or dysplasia, particularly at multiple sites, because of prolonged exposure to higher concentrations of carcinogenic ethanol and acetaldehyde. A questionnaire asking about current and past facial flushing after drinking a glass (approximately 180 ml) of beer is a reliable tool for detecting the presence of inactive ALDH2. Multiple or large esophageal dysplasia, melanosis in the palate, pharynx, and esophagus, and high mean corpuscular volume serve as high‒risk markers for field cancerization in the esophagus and head and neck. Drinking modulation, drinking cessation, smoking cessation, and high intake of fruit and vegetables decrease the risk of esophageal cancer in a dose‒dependent manner.
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