Digestive Diseases and Sciences

, Volume 56, Issue 6, pp 1707–1717

Smoking and Barrett’s Esophagus in Women Who Undergo Upper Endoscopy

  • Brian C. Jacobson
  • Edward L. Giovannucci
  • Charles S. Fuchs
Original Article

DOI: 10.1007/s10620-011-1672-4

Cite this article as:
Jacobson, B.C., Giovannucci, E.L. & Fuchs, C.S. Dig Dis Sci (2011) 56: 1707. doi:10.1007/s10620-011-1672-4



Cigarette use is associated with esophageal adenocarcinoma, and cross-sectional studies suggest an association between smoking and Barrett’s esophagus.


We sought to examine prospectively the effect of smoking on the risk for Barrett’s esophagus.


This was a prospective cohort study among 20,863 women within the Nurses’ Health Study who underwent upper gastrointestinal endoscopy for any reason between 1980 and 2006. We assessed the association between smoking and pathologically-confirmed Barrett’s esophagus (n = 377). Self-reported data on smoking and potential confounding variables were collected from biennial questionnaires.


Compared with women who never smoked, former smokers of 1–24 cigarettes/day had a multivariate odds ratio for Barrett’s esophagus of 1.25 (95% CI 0.99–1.59), former smokers of ≥25 cigarettes/day had a multivariate odds ratio of 1.52 (95% CI 1.04–2.22), current smokers of 1–24 cigarettes/day had a multivariate odds ratio of 0.89 (95% CI 0.54–1.45), and current smokers of ≥25 cigarettes/day had a multivariate odds ratio of 0.92 (95% CI 0.34–2.54). The risk for Barrett’s esophagus increased significantly with increasing pack-years smoked among former (P = 0.008) but not current smokers (P = 0.99), especially when considering exposure ≥25 years before index endoscopy. Results were similar among women reporting regular heartburn/acid-reflux one or more times a week, and were not accounted for by changes in weight.


Heavy, remote smoking is associated with an increased risk for Barrett’s esophagus. This finding suggests a long latency period between exposure and development of the disease, even after discontinuation of smoking.


Barrett’s esophagusSmokingCigarettesGastroesophageal refluxGERD



Body mass index


Gastroesophageal reflux disease


Specialized intestinal metaplasia


Metabolic equivalent task


Confidence interval


Odds ratio

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Brian C. Jacobson
    • 1
    • 2
  • Edward L. Giovannucci
    • 3
    • 4
    • 7
  • Charles S. Fuchs
    • 5
    • 6
    • 7
  1. 1.Section of Gastroenterology, Department of MedicineBoston University Medical CenterBostonUSA
  2. 2.Boston University School of MedicineBostonUSA
  3. 3.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  4. 4.Department of NutritionHarvard School of Public HealthBostonUSA
  5. 5.Cancer Epidemiology ProgramDana-Farber and Harvard Cancer CenterBostonUSA
  6. 6.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  7. 7.Channing Laboratory, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA