Disclosures: The authors have no financial disclosures to make. There were no conflicts of interest.
Meta-Analysis and Systematic Review
Cigarette smoking and the risk of Barrett's esophagus: A systematic review and meta-analysis
Article first published online: 22 JUL 2013
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 8, pages 1258–1273, August 2013
How to Cite
Andrici, J., Cox, M. R. and Eslick, G. D. (2013), Cigarette smoking and the risk of Barrett's esophagus: A systematic review and meta-analysis. Journal of Gastroenterology and Hepatology, 28: 1258–1273. doi: 10.1111/jgh.12230
- Issue published online: 22 JUL 2013
- Article first published online: 22 JUL 2013
- Accepted manuscript online: 23 APR 2013 06:21AM EST
- Manuscript Accepted: 4 APR 2013
- Barrett's esophagus;
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.
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.
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.
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.