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Smoking as an independent determinant of Barrett’s esophagus and, to a lesser degree, of reflux esophagitis

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Abstract

Purpose

To evaluate the role of smoking in Barrett’s esophagus (BE) and erosive esophagitis (E) compared to endoscopic controls with no BE or E. Smoking is considered a cause of both BE and E, but results on this topic are quite controversial.

Methods

Patients with BE (339), E (462) and controls (619: 280 with GERD (gastroesophageal reflux disease)-negative and 339 with GERD-positive anamnesis) were recruited in 12 Italian endoscopy units. Data were obtained from structured questionnaires.

Results

Among former smokers, a remarkable upward linear trend was found in BE for all smoking-related predictors. In particular, having smoked for more than 32 years increased the risk more than two times (OR 2.44, 95 % CL 1.33–4.45). When the analysis was performed in the subgroup of subjects with GERD-negative anamnesis, the risk of late quitters (<9 years) passed from OR 2.11 (95 % CL 1.19–3.72) to OR 4.42 (95 % CL 1.52–12.8). A noticeably positive dose–response relationship with duration was seen also among current smokers. As regards E, no straightforward evidence of association was detected, but for an increased risk of late quitters (OR 1.84, 95 % CL 1.14–2.98) in former smokers and for early age at starting (OR 3.63, 95 % CL 1.19–11.1) in GERD-negative current smokers.

Conclusions

Smoking seems to be an independent determinant of BE and, to a lesser degree, of E. The elevation in risk is independent from GERD and is already present in light cigarette smokers. Smoking cessation may reduce, but not remove this risk.

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Acknowledgments

The authors are grateful to Bracco for the financial support of the study. We thank the study participants for their confidence and collaboration.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi, 10, 16132, Genoa, Italy

    Rosa Filiberti & Vincenzo Fontana

  2. Digestive Endoscopy, IRCCS Giovanni Paolo II, Bari, Italy

    Antonella De Ceglie

  3. Gastroenterology, General Hospital, Sanremo, Imperia, Italy

    Sabrina Blanchi & Massimo Conio

  4. Medical Department, Bracco Spa, Milan, Italy

    Enzo Grossi

  5. Digestive Endoscopic Surgery, Spedali Civili di Brescia, Brescia, Italy

    Domenico Della Casa

  6. Endoscopy, Policlinico San Giorgio, Pordenone, Italy

    Teresa Lacchin

  7. Gastroenterology and Digestive Endoscopy, Ospedale di Lavagna, ASL 4 Chiavarese, Lavagna, Italy

    Marina De Matthaeis

  8. Endoscopy, IRCCS, Rionero in Vulture, Potenza, Italy

    Orazio Ignomirelli

  9. Gastroenterology, S. Maria degli Angeli Hospital, Pordenone, Italy

    Roberta Cappiello

  10. Gastroenterology, LARC Private Clinic, Turin, Italy

    Monica Foti

  11. Internal Medicine and Gastroenterology, University & Foundation, Chieti, Italy

    Francesco Laterza

  12. Gastroenterology and Digestive Endoscopy, IRCCS, S. Giovanni Rotondo, Foggia, Italy

    Vito Annese

  13. Gastroenterology and Digestive Endoscopy, S. G. Moscati Hospital, Avellino, Italy

    Gaetano Iaquinto

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  1. Rosa Filiberti
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  2. Vincenzo Fontana
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  3. Antonella De Ceglie
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  7. Teresa Lacchin
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  14. Gaetano Iaquinto
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  15. Massimo Conio
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Correspondence to Rosa Filiberti.

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Filiberti, R., Fontana, V., De Ceglie, A. et al. Smoking as an independent determinant of Barrett’s esophagus and, to a lesser degree, of reflux esophagitis. Cancer Causes Control 26, 419–429 (2015). https://doi.org/10.1007/s10552-014-0518-8

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  • DOI: https://doi.org/10.1007/s10552-014-0518-8

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