We also found tentative evidence that the relationship between cigarette smoking and Venetoclax clinical trial Barrett’s esophagus might be stronger in men, which could indicate sex differences in the role of smoking with respect to pathogenesis of Barrett’s esophagus. Lastly, evidence for biological interaction between heartburn/regurgitation and cigarette smoking suggests varied mechanistic effects of
cigarette smoking in the development of Barrett’s esophagus. Our understanding of the relationship between cigarette smoking and Barrett’s esophagus has been hampered by inconsistent data from studies too small to fully assess the issue; some studies have found evidence for an association using population-based controls,23 and 24 endoscopy-negative controls,18 and 25 or GERD
controls,18, 28, 29 and 30 and other studies have not found evidence for a relationship.47, 48, 49 and 50 The analysis presented here is much larger than any of these previous Sunitinib studies, and this larger sample size provided for greater statistical power and greater precision of risk estimates. In addition, the availability of GERD controls and population-based controls allowed for comparison with the source population undergoing endoscopy and the general population, respectively, with the latter also enabling assessment of heartburn/regurgitation as a potential effect–measure modifier and as a potential synergistic risk factor. A particular strength of the study is its use of pooled
individual patient data through a large international consortium; this method provides more comparable statistical estimates than standard meta-analysis, which pool published ORs that differ in their variable definitions and the confounders included. Therefore, the results of this analysis are the strongest available data to date regarding cigarette smoking as a risk factor for Barrett’s esophagus. Barrett’s esophagus is the recognized precursor lesion of esophageal adenocarcinoma and, if cigarette smoking was a risk factor for Barrett’s esophagus, one can expect to observe an association between smoking and esophageal adenocarcinoma as well. Studies of this malignancy compared with population-based or hospital controls also provide Baricitinib evidence for an association with cigarette smoking,50, 51, 52, 53, 54 and 55 including a recent pooled esophageal adenocarcinoma analysis from the international BEACON group.22 Given the concordance of these data, associations between cigarette smoking and Barrett’s esophagus, as well as cigarette smoking and esophageal adenocarcinoma, are likely to be real and, given the high prevalence of the exposure, might account for a large proportion (∼40%) of esophageal adenocarcinomas.56 It has not been known where smoking acts in the biological pathway. The current data suggest that smoking is associated with the risk of an early cancer precursor, that is, Barrett’s esophagus.
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