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Cigarette smoking increased risk for Barrett’s esophagus
Cigarette smoking was associated with an increased risk for Barrett’s esophagus in a recent study.
The researchers evaluated data from five case-control studies, including 1,059 patients with Barrett’s esophagus, 1,332 patients with GERD, and a 1,143-person control group. The goal of the analysis was to determine an association between smoking and Barrett’s esophagus, as well as whether smoking combined with other exposures would impact an individual’s risk for the illness.
Patients with Barrett’s esophagus were more likely to have ever smoked than those in the GERD (OR=1.61, 95% CI, 1.33-1.96) and population control groups (OR=1.67, 95% CI, 1.04-2.67). An increased amount of smoking was associated with heightened risk for the illness until a plateau at approximately 20 pack-years (the number of packs smoked per day multiplied by the number of years the participant has smoked). The OR for Barrett’s esophagus was approximately 1.5 for both control groups for up to 30 pack-years, and approximately 2 for more than 30 pack-years, but the P value for the trend was only statistically significant when patients who had never smoked were included in the calculation (P=.057 vs. P=.193). Additional variables, including duration, intensity and the age at which the participant began smoking were not associated with Barrett’s esophagus.
Researchers also found an association between smoking and heartburn or regurgitation, with an estimated attributable proportion of 0.39 (95% CI, 0.25-0.52) among participants who had ever smoked and also reported heartburn/regurgitation symptoms. The OR for Barrett’s esophagus was 9.35 (95% CI, 6.08-14.39) for nonsmokers with heartburn or regurgitation; 1.71 (95%CI, 1.04-2.80) for smokers without heartburn/regurgitation, and 16.47 (95% CI, 10.73-25.29) for smokers with heartburn or regurgitation.
“If smoking is a causative agent of Barrett’s esophagus, it is an attractive modifiable risk factor, especially in high-risk groups such as elderly, obese males with GERD symptoms,” the researchers wrote. “In addition, because the origins of Barrett’s esophagus are poorly understood, a better understanding of its risk factors and their biological interactions might allow inference of the biological mechanisms involved in the nascent stages of Barrett’s esophagus.”