Cigarette Smoking Increases Risk of Barrett's Esophagus: An Analysis of the Barrett's and Esophageal Adenocarcinoma Consortium
Cigarette Smoking Increases Risk of Barrett's Esophagus: An Analysis of the Barrett's and Esophageal Adenocarcinoma Consortium
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DOI：
10.1053/j.gastro.2011.12.049
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发表时间：
2012-04-01
期刊：
影响因子：
29.4
通讯作者：
Corley, Douglas A.
中科院分区：
文献类型：
--
作者：
Cook, Michael B.;Shaheen, Nicholas J.;Corley, Douglas A.
背景与目的：吸烟与食管腺癌的病因有关，但吸烟是否是巴雷特食管的危险因素尚不清楚。我们调查了吸烟和其他因素是否增加Barrett食管的风险。方法：我们分析了来自国际Barrett食管腺癌协会的5项病例对照研究的数据。我们使用多变量logistic回归模型比较了Barrett食管受试者（n = 1059）与胃食管反流病受试者（胃食管反流病对照，n = 1332）和基于人群的对照（n = 1143）的数据，以检验与吸烟的相关性。我们还测试了吸烟是否与其他暴露有协同效应，这可能进一步增加Barrett食管的风险。结果：Barrett食管受试者比基于人群的对照组更有可能吸烟（比值比[OR] = 1.67; 95%置信区间[CI]：1.04-2.67）或胃食管反流病对照组（OR = 1.61; 95% CI：1.33-1.96）。吸烟包年数的增加增加了巴雷特食管的风险。有证据表明，吸烟和胃灼热或反流之间的协同作用;在吸烟和胃灼热或反流的个体中，疾病的归因比例估计为0.39（95%CI：0.25-0.52）。这种关联随着吸烟暴露的增加而加强，直到接近20包-年时才开始稳定。吸烟与胃灼热或反流有协同作用，表明吸烟可能通过多种途径促进巴雷特食管的发展。
BACKGROUND & AIMS: Cigarette smoking has been implicated in the etiology of esophageal adenocarcinoma, but it is not clear if smoking is a risk factor for Barrett's esophagus. We investigated whether tobacco smoking and other factors increase risk for Barrett's esophagus.METHODS: We analyzed data from 5 case-control studies included in the international Barrett's and Esophageal Adenocarcinoma Consortium. We compared data from subjects with Barrett's esophagus (n = 1059) with those from subjects with gastroesophageal reflux disease (gastroesophageal reflux disease controls, n = 1332), and population-based controls (n = 1143), using multivariable logistic regression models to test associations with cigarette smoking. We also tested whether cigarette smoking has synergistic effects with other exposures, which might further increase risk for Barrett's esophagus.RESULTS: Subjects with Barrett's esophagus were significantly more likely to have ever smoked cigarettes than the population-based controls (odds ratio [OR] = 1.67; 95% confidence interval [CI]: 1.04-2.67) or gastroesophageal reflux disease controls (OR = 1.61; 95% CI: 1.33-1.96). Increasing pack-years of smoking increased the risk for Barrett's esophagus. There was evidence of a synergy between ever-smoking and heartburn or regurgitation; the attributable proportion of disease among individuals who ever smoked and had heartburn or regurgitation was estimated to be 0.39 (95% CI: 0.25-0.52).CONCLUSIONS: Cigarette smoking is a risk factor for Barrett's esophagus. The association was strengthened with increased exposure to smoking until similar to 20 pack-years, when it began to plateau. Smoking has synergistic effects with heartburn or regurgitation, indicating that there are various pathways by which tobacco smoking might contribute to development of Barrett's esophagus.