title: Smoking as an independent determinant of Barrett's esophagus and, to a lesser degree, of reflux esophagitis.
abstract: OBJECTIVE
  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.
authors.affiliation: Clinical Epidemiology, IRCCS AOU San Martino- IST-Istituto Nazionale per la Ricerca sul Cancro, Largo R. Benzi, 10, 16132, Genoa, Italy, rosa.filiberti@hsanmartino.it.
authors.forename: Rosa
authors.initials: R
authors.lastname: Filiberti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Fontana
authors.forename: Antonella
authors.initials: A
authors.lastname: De Ceglie
authors.forename: Sabrina
authors.initials: S
authors.lastname: Blanchi
authors.forename: Enzo
authors.initials: E
authors.lastname: Grossi
authors.forename: Domenico
authors.initials: D
authors.lastname: Della Casa
authors.forename: Teresa
authors.initials: T
authors.lastname: Lacchin
authors.forename: Marina
authors.initials: M
authors.lastname: De Matthaeis
authors.forename: Orazio
authors.initials: O
authors.lastname: Ignomirelli
authors.forename: Roberta
authors.initials: R
authors.lastname: Cappiello
authors.forename: Monica
authors.initials: M
authors.lastname: Foti
authors.forename: Francesco
authors.initials: F
authors.lastname: Laterza
authors.forename: Vito
authors.initials: V
authors.lastname: Annese
authors.forename: Gaetano
authors.initials: G
authors.lastname: Iaquinto
authors.forename: Massimo
authors.initials: M
authors.lastname: Conio
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000209:etiology*; D016022:Case-Control Studies; D004724:Endoscopy; D004942:Esophagitis, Peptic / Q000209:etiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012306:Risk; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires