Cigarette smoking is a modifiable risk factor for Barrett's oesophagus

Abstract

Background: Cigarette smoking has been associated with an increased risk of oesophageal adenocarcinoma (OAC). However, the impact of smoking and more importantly smoking cessation on Barrett's oesophagus (BO) is unclear. Objective: The aim of the study is to evaluate the association between cigarette smoking and presence of BO in a large prospective cohort of patients with gastro-oesophageal reflux disease (GORD). Methods: Patients presenting to the endoscopy unit for upper endoscopy completed a validated GORD questionnaire and information on demographics (age, gender, and ethnicity), cigarette smoking [status (current/past), amount (pack years) and duration of smoking cessation], clinical data [medication history, body mass index (BMI), and family history] and endoscopic findings [BO and hiatal hernia] were recorded. Cigarette smokers (current and past) and nonsmokers were compared using Fisher's Exact test for categorical variables and Mann-Whitney test for continuous variables. Effects of cigarette smoking and smoking cessation on BO risk was assessed by stepwise logistic regression analysis. Results: A total of 1056 patients were included in the analysis [mean age: 57.2 AE 12.7years, Caucasian 880 (83.3%), male 985 (93.3%), and mean BMI 29.6 (SD: AE 5.6)]. 827 (78.3%) were smokers and 229 (21.6%) were nonsmokers. 474 subjects (44.9%) had a previous history of smoking. Anytime smokers were more likely to have BO (adjusted OR: 3.3; 95 CI: 1.7-6.3; p < 0.01). Higher smoking burden (pack years) was associated with higher risk of BO in this GORD cohort (p for trend < 0.01). Duration of smoking cessation was inversely associated with risk of BO (p for trend: 0.01). Conclusion: This study shows that smokers with reflux symptoms have about threefold higher risk of BO compared with nonsmokers, whereas discontinuing smoking is associated with a significant reduced risk. Smoking cessation appears to be a viable option to reduce BO risk in patients with reflux disease.

Barrett Esophagus

“…Tobacco smoking is associated with higher Barrett esophagus prevalence. In a cohort study of 1056 patients undergoing endoscopy, Barrett esophagus was diagnosed in 12% of people who smoked cigarettes compared with 1.1% of people who did not smoke cigarettes ( P < .001) …”

“…In a cohort study of 1056 patients undergoing endoscopy, Barrett esophagus was diagnosed in 12% of people who smoked cigarettes compared with 1.1% of people who did not smoke cigarettes (P < .001). 10 A systematic review and meta-analysis of 29 cohort studies (24 retrospective and 5 prospective) that included 13 434 patients (mean body mass index range, 39-51.2) undergoing evaluation prior to bariatric surgery reported a pooled prevalence of Barrett esophagus of 0.9% (95% CI, 0.7%-1.3%). This study showed a positive association between mean body mass index and Barrett esophagus prevalence, in which for each 1-point increase in body mass index there was a 0.15% increase in prevalence of Barrett esophagus.…”

A case of simultaneous esophageal squamous cell carcinoma and Barrett’s adenocarcinoma

“…The risk factors for Barrett's adenocarcinoma include male gender, increased age, obesity, smoking, long-segment Barrett's esophagus, reflux esophagitis or symptomatic GERD, non-infection of H. pylori, colorectal tumor, and history of dysplasia or adenocarcinoma [3,4,16,17]. Thus, male gender and age constitute common risk Clin J Gastroenterol factors for both diseases, and it can be said that smoking is another commonality due to many reports of a strong causal relationship between smoking and Barrett's adenocarcinoma [18]. Our findings were consistent with the five above-described case reports of simultaneous esophageal SCC and Barrett's adenocarcinoma.…”

“…In laboratory examinations, serum squamous cell carcinoma-related antigen was slightly increased (1.9 ng/ml) and H. pylori antibody was negative. During positron emission tomography-CT (PET-CT), 18 Ffluorodeoxyglucose was seen integrated into the thickening of the middle intrathoracic esophageal wall as well as multiple mediastinal lymph node swellings, which suggested esophageal cancer and lymph node metastasis ( Fig. 1).…”

Diagnosis and Management of Barrett’s Esophagus

“…Smoking is associated with an increased risk of BE [ 17 , 18 ]. Moreover, the risk of BE increases with higher pack years of cigarette smoking ( p -trend < 0.01) [ 143 ]. Furthermore, the risk of BE decreases with the increasing duration of smoking cessation ( p -trend = 0.01) [ 143 ].…”