Smoking cessation recommended for BE patients
MedWire News: Patients with Barrett's esophagus (BE) should be encouraged to give up smoking, recommend researchers who found that tobacco use doubles the risk for progression to esophageal adenocarcinoma.
However, contrary to previous research, the risk for future malignancy was not linked to alcohol consumption or body size, report Helen Coleman, from Queen's University Belfast, UK, and co-authors.
The team examined the impact of lifestyle factors on the risk for progression from BE to malignant disease using data from 3167 patients in the Northern Ireland BE register who were diagnosed with specialized intestinal metaplasia between 1993 and 2005.
After a mean follow-up of 7.5 years, 117 of the patients were diagnosed with esophageal high-grade dysplasia or adenocarcinoma of the esophagus or gastric cardia by the end of 2008, with an average 4.5 years between BE diagnosis and detection of malignancy.
Patients who currently smoked were significantly more likely to have been diagnosed with malignancy than those who had never smoked, with a hazard ratio (HR) of 2.03, after adjusting for age, gender, presence of low-grade dysplasia, Barrett's segment length, and other confounding factors.
The increased HR for BE progression for cigarette smoking was 0.88 per 5 years of smoking, after adjustment. Pipe smokers were also affected with a HR of 2.95.
As reported in the journal Gastroenterology, intake of 10 U or more of alcohol per week was not significantly predictive of progression compared with a lower alcohol consumption. Nor did type of alcohol consumed alter the risk for malignancy.
The team writes that few patients had both height and weight recorded at time of BE diagnosis, with patients whose BE progressed more likely to have records than those whose did not (30.8 vs 21.9%). However, there was no significant difference in the proportion of patients with and without progression with an overweight or obese body mass index (75.0 vs 68.0%).
Noting that smoking is thought to cause DNA damage to Barrett's mucosa, and may be associated with an increased risk for reflux and low esophageal sphincter pressure, Coleman et al suggest: "Further research into the effects of smoking in Barrett's mucosa would prove useful insights into the mechanisms involved."
Nevertheless, they conclude: "Smoking cessation strategies should be considered for patients with BE."
By Lynda Williams