Cigarette smoking and the risk of Barrett's esophagus: A systematic review and meta‐analysis. Issue 8 (22nd July 2013)

• Record Type: Journal Article
• Authors: Andrici, Juliana; Cox, Michael R; Eslick, Guy D
• Is Part Of: Journal of gastroenterology and hepatology. Volume 28:Issue 8(2013:Aug.)
• Page Start: 1258
• Page End: 1273
• Publication Date: 2013-07-22
• Subjects: Barrett's esophagus -- cigarettes -- meta‐analysis -- smoking -- tobacco; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.12230
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: Barrett's esophagus (BE) is a premalignant condition to esophageal adenocarcinoma. It is currently not clear whether cigarette smoking increases the risk of developing BE, and no meta‐analysis has been performed on the topic. We conducted a systematic review and meta‐analysis, providing a quantitative estimate of the increased risk of BE associated with cigarette smoking, to help clarify whether a relationship exists between smoking and BE. Methods: Four electronic databases (Medline, PubMed, Embase, and Current Contents Connect) were searched to May 17, 2013, for observational studies of BE patients. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using a random effects model for the association of smoking with BE. BE patients were compared with non‐gastroesophageal reflux disease (GERD) controls as well as with population‐based and GERD controls. Results: Thirty‐nine studies comprising 7069 BE patients were included in the meta‐analysis. Having ever‐smoked was associated with an increased risk of BE compared with non‐GERD controls (OR 1.44; 95% CI 1.20–1.74), population‐based controls (OR 1.42; 95% CI 1.15–1.76), but not GERD controls (OR 1.18; 95% CI 0.75–1.86). The meta‐analyses of the studies reporting the lowest and highest number of pack‐years smoked showed an increased risk of BE (OR 1.41; 95% CI 1.22–1.63) and (OR 1.53; 95% CI 1.27–1.84), respectively. Conclusion: Cigarette smoking was associated with an increased risk of BE. Being an ever‐smoker was associated with an increased risk of BE in all control groups. A greater number of pack‐years smoked was associated with a greater risk of BE.