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No Significant Effects of Smoking or Alcohol Consumption on Risk of Barrett’s Esophagus

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Abstract

Background

Smoking, but not higher alcohol consumption, is associated with increased risk of esophageal adenocarcinoma (EAC) and progression from Barrett’s esophagus (BE) to EAC. However, it is still unclear whether smoking or alcohol is implicated in the development of BE.

Aim

To evaluate the associations between smoking, alcohol and the risk of BE.

Methods

The study included eligible patients scheduled for elective esophagogastroduodenoscopy (EGD) and a sample of patients eligible for screening colonoscopy recruited from primary care clinics. We compared 258 patients with definitive BE with two separate control groups: 453 patients from the primary care group (“colonoscopy controls”) and 1,145 patients from the elective EGD group (“endoscopy controls”) with no endoscopic or histopathologic BE. We calculated odds ratios (OR) and 95 % confidence intervals (95 % CI) using multivariable logistic regression models.

Results

Seventy-seven percent of BE cases, 75 % of colonoscopy controls and 72 % of endoscopy controls were ever smokers. Of these, approximately 45 % were current smokers. Overall, 91 % of study participants were ex or current alcohol drinkers, with the majority drinking beer. We found no association between various measure of smoking exposure (status, intensity, age at initiation, duration, pack-years and cessation) and risk of BE. Alcohol consumption was not associated with increased risk of BE. Conversely, moderate intake was associated with lower risk (14 to <28 drinks/week, OR 0.39, 95 % CI 0.15–1.00).

Conclusion

Smoking and alcohol were not strong or consistent risk factors for BE. The likely role of smoking in increasing risk of EAC is through promoting progression from BE to cancer.

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Acknowledgments

APT is supported by a Fellowship from the National Health and Medical Research Council of Australia (APP1052219). HES is supported by NCI R01 116845 and NIDDK K24-04-107. The work is supported in part by the Houston VA HSR&D Center of Excellence (HFP90-020), and by the Texas Digestive Disease Center NIH DK58338.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia

    Aaron P. Thrift

  2. Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Aaron P. Thrift

  3. Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Jennifer R. Kramer, Peter A. Richardson & Hashem B. El-Serag

  4. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Jennifer R. Kramer, Peter A. Richardson & Hashem B. El-Serag

  5. Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Hashem B. El-Serag

  6. Royal Brisbane Hospital, QIMR Berghofer Medical Research Institute, Locked Bag 2000, Brisbane, QLD, 4029, Australia

    Aaron P. Thrift

Authors
  1. Aaron P. Thrift
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  2. Jennifer R. Kramer
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Correspondence to Aaron P. Thrift.

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Thrift, A.P., Kramer, J.R., Richardson, P.A. et al. No Significant Effects of Smoking or Alcohol Consumption on Risk of Barrett’s Esophagus. Dig Dis Sci 59, 108–116 (2014). https://doi.org/10.1007/s10620-013-2892-6

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  • DOI: https://doi.org/10.1007/s10620-013-2892-6

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