title: Cigarette smoking increases risk of Barrett's esophagus: an analysis of the Barrett's and Esophageal Adenocarcinoma Consortium.
abstract: OBJECTIVE
  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 ∼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.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland 20852-7234, USA. michael.cook@nih.gov
authors.forename: Michael B
authors.initials: MB
authors.lastname: Cook
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Anderson
authors.forename: Carol
authors.initials: C
authors.lastname: Giffen
authors.forename: Wong-Ho
authors.initials: WH
authors.lastname: Chow
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Vaughan
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Corley
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology*; D000368:Aged; D001315:Australia; D001471:Barrett Esophagus / Q000209:etiology*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000209:etiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006356:Heartburn / Q000150:complications; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011230:Precancerous Conditions / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors; D014481:United States