July 31, 2019

Tobacco use and BE

Tobacco use and BE

In this cross-sectional study of patients seen at Mayo Clinic between 2002 and 2010, use of smokeless tobacco and cigars or pipes was found to be associated with risk of Barrett’s in persons with GERD. Confirmatory studies are needed.

Mayo Clin Proc. 2018 Sep;93(9):1282-1289. doi: 10.1016/j.mayocp.2018.04.022.

Smokeless  Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in  Male Patients With Gastroesophageal Reflux Disease.

Westra WM1, Lutzke LS2, Mostafavi NS3, Roes AL4, Calpe S4, Wang KK2, Krishnadath KK5.



To  investigate the effect of smokeless tobacco (ST), cigar and/or pipe  smoking (CP) on the development of Barrett esophagus (BE) in white male  patients with gastroesophageal reflux disease (GERD).


A  total of 1015 records of white male adults with BE (cases; n=508) or  GERD (controls, n=507) were reviewed for lifestyle factors. Logistic  regression analyses were performed after adjusting for lifestyle factors  to assess the effects of ST and CP on the risk of developing BE.  Differences between patients with BE and those with GERD were compared  using chi-square and t tests.


Patients with BE  were significantly older than patients with GERD (mean age, 66±12 years  for patients with BE and 55±15 years for patients with GERD; P<.001).  The odds of developing BE in patients who used CS were 1.7 times higher  than that in patients who never smoked cigarettes (odds ratio [OR],  1.7; 95% CI, 1.3-2.2). It was observed that when CS use was combined  with either ST or CP use, the odds of having BE significantly increased  (OR, 2.5; 95% CI, 1.2-5.2; P=.01 and OR, 1.9; 95% CI, 1.03-3.58; P=.04)  in comparison to CS alone. There were no significant differences in body  mass index and alcohol consumption between BE and GERD groups.


This  study suggests that there is indeed an association between CS and BE.  We believe that this is the first time that ST and CP were associated  with an even higher odds of developing BE. Further studies are needed to  investigate whether the use of ST and CP is also associated with an  increased risk of developing BE-associated adenocarcinoma.