Smoking and Barrett’s Esophagus
New research conducted by the National Cancer Institute shows that smoking is a risk factor for Barrett’s esophagus, among gastroesophageal reflux disease.
Barrett esophagus is a lesion characterized by the appearance of islands of intestinal cells in the esophagus. Normally, the esophagus is covered inside by a lining composed of squamous epithelium. Intestinal epithelium is usually caused by gastroesophageal reflux after repair response due to more rapid regeneration of epithelial ulceration with columnar epithelium. Therefore, Barrett’s esophagus occurs mainly in lower level near the gastroesophageal junction. It is important to notice that Barrett esophagus can be the cause of esophageal cancer.
However, new studies show that smoking is a major risk factor for Barrett’s esophagus. Michael B. Cook, Ph.D., of the National Cancer Institute in Bethesda, Md., nd associates have investigated five case control studies and found that Barrett’s esophagus is more common in people who smoke. Researchers analyzed the cases of 1059 patients with Barrett’s esophagus , 1332 controls with gastroesophageal reflux disease (GERD), and 1143 population-based controls. Moreover, the risk of developing this disease is even greater as the number of cigarettes is greater.
Smoking is considered a risk factor for development of several cancers, most notably is lung cancer. The risk of lung cancer in smokers is 20-30 times higher than in nonsmokers. Besides the action of carcinogenic substances in tobacco smoke, the smoke causes bronchial cell metaplasia which in turn can progress to malignancy. Also, smoking is considered a risk factor for several cancers such as bladder cancer and kidney cancer or oropharyngeal cancer. Regarding the involvement of smoking in Barrett’s esophagus, it is a well-known fact that smoking lowers the alkaline pancreatic secretion and cancel mechanisms of acid secretion inhibitors, leading to gastroduodenal ulcers. These changes are expressed clinical appearance of heartburn, which is a heartburn that disappears to antacids.
The involvement of smoking in the Barrett esophagus is important because Barrett esophagus is one of precancerous lesions. Therefore, American College of Gastroenterology recommends endoscopy of all patients with reflux disease. If damage is found in the esophagus, the doctor can take biopsy for histopathological examination. In case of severe dysplasia, endoscopic mucosal resection is recommended. However, any patient with Barrett’s esophagus should be carefully monitored and evaluated.
Symptoms are similar to gastroesophageal reflux disease, chest pain that is burning nature, that may increase in pain when lying down, etc. Also, it is important to remember that Barrett’s esophagus to cancer is advancing early. Chromosomal aberrations or gene mutations can lead to inactivation of tumor suppressor genes. Once inactivated these genes, cancer cells divide, they begin to grow erratically, causing cancer.