, Volume 56, Issue 6, pp 1707-1717

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

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Abstract

Background

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

Aims

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

Methods

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.

Results

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.

Conclusions

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.

The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. The content is solely the responsibility of the authors and should not be constituted to represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the National Institutes of Health.