Cigarette smoking and the risk of Barrett's esophagus: a systematic review and meta-analysis

J Gastroenterol Hepatol. 2013 Aug;28(8):1258-73. doi: 10.1111/jgh.12230.


Background and aim: Barrett'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 (Medline, PubMed, Embase, and Current Contents Connect) were searched to May 17, 2013, for observational studies of BE patients. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) 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.

Keywords: Barrett's esophagus; cigarettes; meta-analysis; smoking; tobacco.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Barrett Esophagus / etiology*
  • Barrett Esophagus / prevention & control
  • Female
  • Humans
  • Male
  • PubMed
  • Risk
  • Risk Factors
  • Smoking / adverse effects*
  • Time Factors