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Background & AimsAlcohol consumption may increase gastroesophageal reflux symptoms, cause damage to the esophageal mucosa, and/or promote carcinogenesis. However, reports about the association between alcohol and reflux esophagitis, Barrett's esophagus, and esophageal adenocarcinoma are conflicting. MethodsInformation relating to alcohol consumption, at age 21 and 5 years before the interview date, was collected from 230 reflux esophagitis, 224 Barrett's esophagus, and 227 esophageal adenocarcinoma patients and 260 frequency-matched population controls. Logistic regression analyses were used to compare alcohol consumption in the 3 case groups to controls with adjustment for potential confounders. ResultsPopulation controls reporting gastroesophageal reflux symptoms were less likely than controls without symptoms to drink alcohol 5 years before the interview date (odds ratio [OR], 0.44, 0.20–0.99). No associations were observed between total alcohol consumption 5 years before the interview date and reflux esophagitis, Barrett's esophagus, or esophageal adenocarcinoma (OR, 1.26, 0.78–2.05; OR, 0.72, 0.43–1.21; and OR, 0.75, 0.46–1.22, respectively). Wine was inversely associated with reflux esophagitis (OR, 0.45, 0.27–0.75). Total alcohol consumption at age 21 years was significantly associated with reflux esophagitis (OR, 2.24, 1.35–3.74) but not with Barrett's esophagus or esophageal adenocarcinoma (OR, 1.06, 0.63–1.79 and OR, 1.27, 0.77–2.10, respectively). ConclusionsAlcohol consumption in early adulthood may lead to the development of reflux esophagitis. More recent alcohol consumption does not appear to confer any increased risk of reflux esophagitis, Barrett's esophagus, or esophageal adenocarcinoma. In fact, wine consumption may reduce the risk of these 3 esophageal disorders. Abbreviations used in this paper: BE, Barrett's esophagus, EAC, esophageal adenocarcinoma, GER, gastroesophageal reflux, RE, reflux esophagitis ⁎ Centre for Public Health, Queen's University, Belfast, Northern Ireland ‡ Royal Group of Hospitals, Belfast, Northern Ireland § Daisy Hill Hospital, Newry, Northern Ireland ∥ National Cancer Registry, Cork, Ireland ¶ St. James's Hospital, Dublin, Ireland
This article has an accompanying continuing medical education activity on page 1104. Learning Objective—At the end of this activity, the successful learner should be able to identify the strengths and limitations of case-control studies in examining risk factors for reflux esophagitis and to interpret the findings of a case-control study. Conflict of interest The authors disclose no conflicts. Funding Supported by an Ireland-Northern Ireland Co-operation Research Project Grant sponsored by the Northern Ireland Research & Development Office, by the Health Research Board, Ireland, and by the Ulster Cancer Foundation. PII: S0016-5085(08)02180-X doi:10.1053/j.gastro.2008.12.005 © 2009 AGA Institute. Published by Elsevier Inc. All rights reserved.
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ABSTRACT
The Association Between Alcohol and Reflux Esophagitis, Barrett's Esophagus, and Esophageal Adenocarcinoma