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Cigarette smoking and the risk of B arrett's esophagus: A systematic review and meta‐analysis
Author(s) -
Andrici Juliana,
Cox Michael R,
Eslick Guy D
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12230
Subject(s) - medicine , gerd , meta analysis , odds ratio , confidence interval , gastroenterology , population , barrett's esophagus , esophagus , risk factor , reflux , disease , adenocarcinoma , cancer , environmental health
Background and Aim B arrett's esophagus ( BE ) is a premalignant condition to esophageal adenocarcinoma. It is currently not clear whether cigarette smoking increases the risk of developing BE , and no meta‐analysis has been performed on the topic. We conducted a systematic review and meta‐analysis, providing a quantitative estimate of the increased risk of BE associated with cigarette smoking, to help clarify whether a relationship exists between smoking and BE . Methods Four electronic databases ( M edline, P ub M ed, E mbase, and C urrent C ontents C onnect) were searched to May 17, 2013, for observational studies of BE patients. We calculated pooled odds ratios ( OR s) and 95% confidence intervals ( CI s) using a random effects model for the association of smoking with BE . BE patients were compared with non‐gastroesophageal reflux disease ( GERD ) controls as well as with population‐based and GERD controls. Results Thirty‐nine studies comprising 7069 BE patients were included in the meta‐analysis. Having ever‐smoked was associated with an increased risk of BE compared with non‐ GERD controls ( OR 1.44; 95% CI 1.20–1.74), population‐based controls ( OR 1.42; 95% CI 1.15–1.76), but not GERD controls ( OR 1.18; 95% CI 0.75–1.86). The meta‐analyses of the studies reporting the lowest and highest number of pack‐years smoked showed an increased risk of BE ( OR 1.41; 95% CI 1.22–1.63) and ( OR 1.53; 95% CI 1.27–1.84), respectively. Conclusion Cigarette smoking was associated with an increased risk of BE . Being an ever‐smoker was associated with an increased risk of BE in all control groups. A greater number of pack‐years smoked was associated with a greater risk of BE .