Cigarette smoking and the risk of Barrett's esophagus

We examined the association between smoking and the risk of Barrett's esophagus (BE), a metaplastic precursor to esophageal adenocarcinoma. We conducted a case-control study within the Kaiser Permanente Northern California population. Patients with a new diagnosis of BE (n = 320) were matched to persons with gastroesophageal reflux disease (GERD) (n = 316) and to population controls (n = 317). Information was collected using validated questionnaires from direct in-person interviews and electronic databases. Analyses used multivariate unconditional logistic regression that controlled for age, gender, race, and education. Ever smoking status, smoking intensity (pack-years), and smoking cessation were not associated with the risk of BE. Stratified analyses suggested that ever smoking may be associated with an increased risk of BE among some groups (compared to population controls): persons with long-segment Barrett's esophagus (odds ratio [OR] = 1.72, 95% confidence interval [CI] 1.12-2.63); subjects without GERD symptoms (OR = 3.98, 95% CI 1.58-10.0); obese subjects (OR = 3.38, 95% CI 1.46-7.82); and persons with a large abdominal circumference (OR = 3.02, 95% CI (1.18-2.75)). Smoking was not a strong or consistent risk factor for BE in a large community-based study, although associations may be present in some population subgroups.