吸烟是 Barrett 食管的可改变的风险因素。
Cigarette smoking is a modifiable risk factor for Barrett's oesophagus.
机构信息
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MO, USA.
Gastroenterology and Hepatology, Loyola University Medical Center, Maywood, IL, USA.
出版信息
United European Gastroenterol J. 2013 Dec;1(6):430-7. doi: 10.1177/2050640613504917.
BACKGROUND
Cigarette smoking has been associated with an increased risk of oesophageal adenocarcinoma (OAC). However, the impact of smoking and more importantly smoking cessation on Barrett's oesophagus (BO) is unclear.
OBJECTIVE
The aim of the study is to evaluate the association between cigarette smoking and presence of BO in a large prospective cohort of patients with gastro-oesophageal reflux disease (GORD).
METHODS
Patients presenting to the endoscopy unit for upper endoscopy completed a validated GORD questionnaire and information on demographics (age, gender, and ethnicity), cigarette smoking [status (current/past), amount (pack years) and duration of smoking cessation], clinical data [medication history, body mass index (BMI), and family history] and endoscopic findings [BO and hiatal hernia] were recorded. Cigarette smokers (current and past) and nonsmokers were compared using Fisher's Exact test for categorical variables and Mann-Whitney test for continuous variables. Effects of cigarette smoking and smoking cessation on BO risk was assessed by stepwise logistic regression analysis.
RESULTS
A total of 1056 patients were included in the analysis [mean age: 57.2 ± 12.7years, Caucasian 880 (83.3%), male 985 (93.3%), and mean BMI 29.6 (SD: ± 5.6)]. 827 (78.3%) were smokers and 229 (21.6%) were nonsmokers. 474 subjects (44.9%) had a previous history of smoking. Anytime smokers were more likely to have BO (adjusted OR: 3.3; 95 CI: 1.7-6.3; p < 0.01). Higher smoking burden (pack years) was associated with higher risk of BO in this GORD cohort (p for trend < 0.01). Duration of smoking cessation was inversely associated with risk of BO (p for trend: 0.01).
CONCLUSION
This study shows that smokers with reflux symptoms have about threefold higher risk of BO compared with nonsmokers, whereas discontinuing smoking is associated with a significant reduced risk. Smoking cessation appears to be a viable option to reduce BO risk in patients with reflux disease.
背景
吸烟与食管腺癌（OAC）风险增加有关。然而，吸烟的影响，更重要的是戒烟对巴雷特食管（BO）的影响尚不清楚。
目的
本研究旨在评估在一大群胃食管反流病（GORD）患者中，吸烟与 BO 存在之间的关联。
方法
就诊于内镜科行上消化道内镜检查的患者完成了一份经过验证的 GORD 问卷，内容包括人口统计学信息（年龄、性别和种族）、吸烟情况[吸烟状态（当前/既往）、吸烟量（包年数）和戒烟持续时间]、临床数据[药物史、体重指数（BMI）和家族史]和内镜检查结果[BO 和食管裂孔疝]。使用 Fisher 确切检验比较吸烟者（当前和既往）和非吸烟者的分类变量，使用 Mann-Whitney 检验比较连续变量。使用逐步逻辑回归分析评估吸烟和戒烟对 BO 风险的影响。
结果
共纳入 1056 例患者进行分析[平均年龄：57.2±12.7 岁，白种人 880 例（83.3%），男性 985 例（93.3%），平均 BMI 为 29.6（标准差：±5.6）]。827 例（78.3%）为吸烟者，229 例（21.6%）为不吸烟者。474 例（44.9%）有吸烟史。任何时候吸烟的人更有可能患有 BO（调整后的 OR：3.3；95%CI：1.7-6.3；p<0.01）。在该 GORD 队列中，较高的吸烟量（包年数）与 BO 风险增加相关（p 趋势<0.01）。戒烟持续时间与 BO 风险呈负相关（p 趋势：0.01）。
结论
本研究表明，有反流症状的吸烟者患 BO 的风险比不吸烟者高约三倍，而戒烟与显著降低风险相关。戒烟似乎是减少反流病患者 BO 风险的可行选择。
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