New thesis examines how esophageal cancer can be prevented
Johan Hardvik Åkerström, Upper Gastrointestinal Surgery research group, will defend his thesis "Prevention of esophageal adenocarcinoma" on October 9, in which he has investigated the opportunities of preventing esophageal adenocarcinoma by treating two of the disease's key risk factors: gastroesophageal reflux and obesity.
”My thesis aims to provide new insights into opportunities for preventing esophageal adenocarcinoma, which is the most common histological type of esophageal cancer in Western countries, following a rapid increase in incidence over recent decades," says Johan Hardvik Åkerström, doctoral student at the Upper Gastrointestinal Surgery research group at the Department of Molecular Medicine and Surgery, Karolinska Institutet.
Which are the most important results?
”Esophageal adenocarcinoma is preceded by the precursor lesion Barrett’s esophagus, which has a prevalence of 1-2% in Western populations and carries a substantial risk of progression to esophageal adenocarcinoma. This makes patients with Barrett’s esophagus suitable for preventive actions and differentiates esophageal adenocarcinoma from many other malignancies without such a distinct high-risk group. Gastroesophageal reflux is a strong risk factor for Barrett’s esophagus and consequently for esophageal adenocarcinoma. Using Nordic registry data, we therefore examined whether effective treatment of gastroesophageal reflux with antireflux surgery in patients with Barrett’s esophagus decreases the risk of progression to esophageal adenocarcinoma. There was, however, no indication of a decreased risk after antireflux surgery. Instead, the risk rather increased over time in these patients with Barrett’s esophagus and severe gastroesophageal reflux who had undergone antireflux surgery”.
”Using Nordic registry data, we also investigated whether treatment of the other main risk factor for esophageal adenocarcinoma, obesity, influences the risk of developing this malignancy. Treatment with glucagon-like peptide-1 receptor agonists and bariatric surgery overall were evaluated, with no indication of a decreased risk after either treatment. However, gastric bypass specifically was associated with a decreased risk of esophageal adenocarcinoma. Additionally, we performed a systematic review and meta-analysis, which also showed an association between gastric bypass and a decreased risk of esophageal adenocarcinoma. Notably, the meta-analysis provided some evidence of an increased risk of esophageal adenocarcinoma following sleeve gastrectomy, which is the most commonly performed bariatric surgery globally and a procedure that promotes gastroesophageal reflux”.
How can this new knowledge contribute to the improvement of people’s health?
”The results included in this thesis have implications for the care of patients with Barrett’s esophagus, indicating no rationale for antireflux surgery for cancer-protective reasons. Additionally, the results provide support for the practice of choosing gastric bypass over sleeve gastrectomy for patients with gastroesophageal reflux disease, and provide some support for the recommendation of endoscopic surveillance of patients who have undergone sleeve gastrectomy”.
What are your future ambitions?
”I hope to continue with this kind of research alongside clinical work,” says Johan Hardvik Åkerström.
Dissertation
Friday 9th October 2026 at 10:00, Samuelssonsalen, Tomtebodavägen 6, Karolinska Institutet. The thesis has been supervised by Jesper Lagergren.
Thesis
Hardvik Åkerström, Johan (2026). Prevention of esophageal adenocarcinoma. Karolinska Institutet. Thesis. https://doi.org/10.69622/32261475