Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: Results from the FINBAR study

Table 1 Characteristics of controls, Barrett’s and oesophageal adenocarcinoma patients

Variables	Controls	Barrett’s oesophagus	P(BO vs controls)	Oesophagealadenocarcinoma	P(OAC vs controls)
Sex , n (%)			0.548		0.992
Male	220 (84.6)	185 (82.6)		192 (84.6)
Female	40 (15.4)	39 (17.4)		35 (15.4)
Age			0.567		0.276
Mean years	63	62.4		64.2
Education			0.013		< 0.001
Years (full-time)	12	11.3		10.7
Job type			0.016		0.013
Manual	119 (48.0)	130 (59.1)		128 (59.5)
Non-manual	129 (52.0)	90 (40.9)		87 (40.5)
Alcohol, n (%)			0.135		0.004
Never	69 (26.5)	57 (25.6)		65 (28.9)
Ever	191 (73.5)	166 (74.4)		160 (71.1)
Mean (grams/d)	26.1	22.3		19.2
GOR frequent, n (%)			< 0.01		< 0.001
Never	211 (81.2)	60 (26.8)		117 (51.5)
Ever	49 (18.8)	164 (73.2)		110 (48.5)
Body mass index			0.895		< 0.001
Mean	27	27		28.7
Fruit			< 0.001		< 0.001
Frequency per week	14.2	11.9		11.2
Vegetables			0.04		0.348
Frequency per week	20	18.7		20.6
Total energy intake (kcal)			0.036		0.023
Mean	2573.9	2727.2		2744.2
Smoking status, n (%)			0.4		< 0.001
Never	102 (40.2)	87 (39.2)		45 (20.4)
Ex-smoker	107 (42.1)	85 (38.3)		99 (44.8)
Current	45 (17.7)	50 (22.5)		77 (34.8)

BO: Barrett’s oesophagus; OAC: oesophageal adenocarcinoma; GOR: gastro-oesophageal reflux.

Table 2 Comparison of gastro-oesophageal reflux symptoms between controls and Barrett’s oesophagus and oesophageal adenocarcinoma patients and between oesophageal and junctional tumour subgroups

	ControlsNo.	BENo.	Adjusted1OR (95% CI)	EACNo.	Adjusted1OR (95% CI)	OesophagealtumoursNo.	Adjusted1OR (95% CI)	JunctionaltumoursNo.	Adjusted1OR (95% CI)
Frequent GOR2
No	211	60	1.00	117	1.00	64	1.00	51	1.00
Yes	49	164	12.0 (7.64 to 18.7)	110	3.48 (2.25 to 5.41)	67	3.73 (2.27 to 6.13)	41	3.12 (1.79 to 5.43)
Nocturnal symptoms3
No	237	110	1.00	167	1.00	86	1.00	79	1.00
Yes	23	113	10.9 (6.49 to 18.5)	60	3.16 (1.81 to 5.51)	45	4.53 (2.49 to 8.22)	13	1.45 (0.67 to 3.14)
Reflux symptom score4
No GOR	211	54	1.00	116	1.00	63	1.00	51	1.00
1-4 points	25	63	10.4 (5.90 to 18.5)	53	3.63 (2.06 to 6.40)	22	2.59 (1.30 to 5.15)	30	4.99 (2.58 to 9.62)
4.5-6.5 points	24	107	18.4 (10.5 to 32.3)	58	3.55 (2.02 to 6.27)	46	5.11 (2.78 to 9.38)	11	1.52 (0.66 to 3.47)
Symptom frequency in tertiles (t/yr)
No GOR	211	61	1.00	117	1.00	64	1.00	51	1.00
< 208	17	44	9.34 (4.88 to 17.9)	33	2.94 (1.50 to 5.77)	18	2.96 (1.38 to 6.35)	14	2.81 (1.23 to 6.41)
208-365	23	50	7.86 (4.36 to 14.2)	35	2.75 (1.49 to 5.07)	18	2.53 (1.23 to 5.19)	16	2.94 (1.38 to 6.29)
> 365	9	69	29.2 (13.3 to 64.5)	42	6.54 (2.93 to 14.6)	31	8.20 (3.51 to 19.1)	11	4.50 (1.69 to 12.0)
Duration of symptoms in tertiles (yr)
No GOR	211	54	1.00	116	1.00	63	1.00	51	1.00
< 10	18	64	11.9 (6.37 to 22.1)	39	3.67 (1.94 to 6.97)	16	2.67 (1.25 to 5.72)	22	5.00 (2.38 to 10.5)
10-22.6	15	38	8.09 (4.09 to 16.0)	21	2.28 (1.08 to 4.83)	18	3.57 (1.62 to 7.86)	3	0.78 (0.21 to 2.88)
> 22.6	16	68	16.0 (8.38 to 30.5)	51	4.41 (2.30 to 8.48)	34	5.11 (2.51 to 10.4)	16	3.41 (1.52 to 7.65)

BO: Barrett’s oesophagus; OAC: oesophageal adenocarcinoma; GOR: gastro-oesophageal reflux; OR: odds ratio; CI: confidence interval.

¹Adjusted for sex, age at interview date, body mass index (5 yr prior to the interview date), smoking status (never, ex-, current), alcohol intake (grams), years of full-time education and job type (manual, non-manual).

²Symptoms of heartburn and/or reflux more than 50 times per year.

³Symptoms of GOR that prevented sleep or woke the person from sleep.

⁴Reflux symptom score[14]. Heartburn or regurgitation only = 1 point, GOR symptoms 2 to 6 times per week = 1 point, heartburn and regurgitation = 1.5 points, nightly symptoms = 2 points, GOR symptoms 7 to 15 times per week = 2 points, symptoms more than 15 times per week = 3 points.

Table 3 Body mass index and weight comparisons between controls and Barrett’s oesophagus and oesophageal adenocarcinoma patients

	Controls	Barrett's oesophagus			Oesophageal adenocarcinoma
	No.	No.	Adjusted1OR (95% CI)	Further adjustedfor GOROR (95% CI)	No.	Adjusted1OR (95% CI)	Further adjustedfor GOROR (95% CI)
Current BMI in tertiles (kg/m2)
< 25.8	86	77	1.00	1.00	115	1.00	1.00
25.8-29.0	87	64	0.75 (0.47 to 1.19)	0.61 (0.36 to 1.03)	54	0.38 (0.24 to 0.62)	0.35 (0.21 to 0.58)
> 29.0	85	82	0.97 (0.61 to 1.52)	0.75 (0.44 to 1.25)	50	0.38 (0.23 to 0.62)	0.33 (0.20 to 0.56)
BMI 5 yr ago in tertiles (kg/m2)
< 25.0	86	75	1.00	1.00	51	1.00	1.00
25.0-28.1	87	78	1.02 (0.65 to 1.61)	0.84 (0.50 to 1.42)	55	1.23 (0.72 to 2.08)	1.74 (0.66 to 1.97)
> 28.1	86	71	0.89 (0.56 to 1.41)	0.85 (0.51 to 1.44)	120	2.70 (1.65 to 4.41)	2.69 (1.62 to 4.46)
BMI age 21 in tertiles (kg/m2)
< 22.1	81	70	1.00	1.00	55	1.00	1.00
22.1-24.1	88	80	0.96 (0.61 to 1.52)	1.17 (0.70 to 1.99)	64	0.97 (0.59 to 1.60)	1.10 (0.65 to 1.85)
> 24.1	84	69	0.83 (0.51 to 1.33)	1.04 (0.61 to 1.79)	96	1.59 (0.97 to 2.59)	1.81 (1.08 to 3.02)
Maximum weight in tertiles (kg)2
< 73	87	72	1.00	1.00	53	1.00	1.00
73-86	91	89	1.21 (0.76 to 1.95)	1.04 (0.61 to 1.79)	67	1.54 (0.90 to 2.61)	1.42 (0.83 to 2.45)
> 86	80	62	0.98 (0.58 to 1.66)	0.91 (0.50 to 1.66)	104	3.44 (1.97 to 5.98)	3.32 (1.88 to 5.86)
Minimum weight in tertiles (kg)2
< 64	108	102	1.00	1.00	79	1.00	1.00
64-70	81	61	0.83 (0.52 to 1.34)	1.00 (0.58 to 1.72)	52	1.10 (0.65 to 1.86)	1.20 (0.70 to 2.08)
> 70	70	60	0.97 (0.57 to 1.64)	1.25 (0.69 to 2.27)	95	2.83 (1.63 to 4.89)	3.22 (1.82 to 5.71)

GOR: gastro-oesophageal reflux; OR: odds ratio; CI: confidence interval.

¹Adjusted for sex, age at interview date, smoking status (never, ex-, current), alcohol intake (grams), years of full-time education and job type (manual, non-manual).

²Also adjusted for height (centimetres). ^bP≤ 0.001.

Table 4 Comparison of fruit and vegetable consumption (5 yr before interview date) between controls and Barrett’s oesophagus and oesophageal adenocarcinoma patients

	Controls	Barrett's Oesophagus			Oesophageal adenocarcinoma
	No.	No.	Adjusted1OR (95% CI)	Adjusted1 + GOROR (95% CI)	No.	Adjusted1OR (95% CI)	Adjusted1 + GOROR (95% CI)
Fruit and vegetables (portions/wk)
<20	85	105	1.00	1.00	98	1.00	1.00
20-34	86	58	0.58 (0.36 to 0.92)	0.50 (0.30 to 0.84)	61	0.64 (0.39 to 1.04)	0.60 (0.36 to 1.00)
> 34	86	60	0.61 (0.38 to 0.98)	0.67 (0.40 to 1.15)	65	0.67 (0.41 to 1.12)	0.71 (0.43 to 1.19)
Fruit (portions/wk)
< 5	83	94	1.00	1.00	109	1.00	1.00
5-20	87	76	0.78 (0.49 to 1.23)	0.91 (0.55 to 1.51)	63	0.52 (0.32 to 0.85)	0.56 (0.34 to 0.92)
> 20	87	53	0.57 (0.35 to 0.94)	0.64 (0.37 to 1.12)	53	0.47 (0.28 to 0.80)	0.50 (0.30 to 0.86)
Vegetables (portions/wk)
< 12	83	90	1.00	1.00	66	1.00	1.00
12-17	85	68	0.76 (0.48 to 1.21)	0.75 (0.45 to 1.25)	71	1.13 (0.68 to 1.86)	1.12 (0.67 to 1.87)
> 17	89	65	0.72 (0.44 to 1.15)	0.82 (0.48 to 1.39)	87	1.38 (0.84 to 2.28)	1.49 (0.89 to 2.48)

GOR: gastro-oesophageal reflux; OR: odds ratio; CI: confidence interval.

¹Adjusted for sex, age at interview date, smoking status (never, ex-, current), alcohol intake (grams), energy intake (kilocalories), body mass index (5 yr prior to interview), years of full-time education and job type (manual, non-manual).

Table 5 Smoking in controls, Barrett’s oesophagus and oesophageal adenocarcinoma patients

	Controls	Barrett's oesophagus			Oesophageal adenocarcinoma
	No.	No.	Adjusted1OR (95% CI)	Further adjusted for GOROR (95% CI)	No.	Adjusted1OR (95% CI)	Further adjusted for GOROR (95% CI)
Smoking status (5 yr prior to interview)
Never2	102	87	1.00	1.00	46	1.00	1.00
Ex-smoker	107	85	0.97 (0.63 to 1.49)	0.86 (0.53 to 1.40)	99	1.85 (1.15 to 2.97)	1.72 (1.06 to 2.81)
Current smoker	45	50	1.27 (0.74 to 2.17)	1.41 (0.77 to 2.58)	77	4.64 (2.64 to 8.17)	4.84 (2.72 to 8.61)
No. of cigarettes smoked per day
Never2	102	87	1.00	1.00	46	1.00	1.00
< 15	54	41	0.94 (0.57-1.57)	0.98 (0.55 to 1.75)	44	1.85 (1.07-3.20)	1.87 (1.06 to 3.28)
15-20	51	41	0.98 (0.58-1.65)	0.94 (0.52 to 1.69)	67	3.14 (1.83-5.37)	3.05 (1.76 to 5.30)
> 20	49	53	1.32 (0.78-2.22)	1.16 (0.65 to 2.09)	66	2.92 (1.68-5.10)	2.72 (1.54 to 4.80)
Duration of smoking (yr)
Never2	102	87	1.00	1.00	46	1.00	1.00
< 20	47	28	0.72 (0.41 to 1.28)	0.72 (0.38 to 1.38)	38	1.92 (1.07 to 3.44)	1.91 (1.05 to 3.48)
20-35	55	57	1.21 (0.74 to 1.98)	1.09 (0.62 to 1.90)	54	2.08 (1.21 to 3.58)	1.94 (1.11 to 3.38)
> 35	53	51	1.18 (0.70 to 1.98)	1.18 (0.66 to 2.11)	85	3.74 (2.18 to 6.40)	3.71 (2.14 to 6.42)
Years since quitting smoking
Never2	102	87	1.00	1.00	46	1.00	1.00
< 26	27	29	1.27 (0.74 to 2.19)	1.42 (0.78 to 2.60)	36	4.72 (2.68 to 8.31)	4.89 (2.74 to 8.71)
26-41	40	32	1.26 (0.68 to 2.33)	1.11 (0.56 to 2.20)	29	2.68 (1.42 to 5.07)	2.51 (1.30 to 4.83)
> 41	40	24	1.02 (0.58 to 1.81)	0.89 (0.47 to 1.70)	34	1.52 (0.82 to 2.85)	1.40 (0.74 to 2.66)
Pack years of smoking
Never2	102	87	1.00	1.00	46	1.00	1.00
< 15	48	36	0.92 (0.54 to 1.57)	0.94 (0.51 to 1.72)	30	1.39 (0.76 to 2.55)	1.39 (0.75 to 2.58)
15-40	55	47	1.01 (0.61 to 1.67)	0.92 (0.52 to 1.63)	68	2.95 (1.74 to 5.00)	2.84 (1.66 to 4.86)
> 40	51	52	1.28 (0.76 to 2.17)	1.23 (0.68 to 2.21)	79	3.48 (2.01 to 6.02)	3.34 (1.91 to 5.83)
Cigar
Never	234	204	1.00	1.00	194	1.00	1.00
Ever	22	18	0.84 (0.41 to 1.71)3	0.73 (0.33 to 1.61)3	29	1.30 (0.67 to 2.53)3	1.22 (0.61 to 2.43)3
Pipe
Never	233	194	1.00	1.00	182	1.00	1.00
Ever	23	28	1.68 (0.88 to 3.20)3	1.31 (0.64 to 2.68)3	41	1.64 (0.88 to 3.06)3	1.45 (0.77 to 2.75)3

GOR: gastro-oesophageal reflux; OR: odds ratio; CI: confidence interval.

¹Adjusted for sex, age at interview date, body mass index 5 yr prior to the interview date, alcohol intake (grams), years of full-time education and job type (manual, non-manual).

²Never smoked, smoked less than 100 cigarettes in lifetime or smoked less than 1 cigarette per day for 6 mo in their lifetime

³Adjusted for use of other tobacco products e.g. cigarettes, pipe or cigar respectively.