Date Published: February 15, 2018
Publisher: Public Library of Science
Author(s): Atsuhiro Masuda, Tsuyoshi Fujita, Manabu Murakami, Yukinao Yamazaki, Masao Kobayashi, Shuichi Terao, Tsuyoshi Sanuki, Akihiko Okada, Masayasu Adachi, Hideyuki Shiomi, Yoshifumi Arisaka, Hiromu Kutsumi, Eiji Umegaki, Takeshi Azuma, Wayne A. Phillips.
The association of alcohol intake with the incidence of Barrett’s esophagus (BE) has been inconsistent. Although hiatal hernia and male sex are well-known risk factors of BE, its effect on the association of alcohol intake with the incidence of BE remains unknown.
To investigate whether the influence of alcohol intake on the occurrence of BE might differ depending on male sex and presence of hiatal hernia.
We utilized a database of 8031 patients that underwent upper endoscopy for health screening in a prospective, multicenter, cohort study (the Upper Gastro Intestinal Disease study). The incidence of endoscopic columnar-lined esophagus (eCLE; endoscopically diagnosed BE) was the outcome variable. Multivariable logistic regression analysis was conducted to assess the association between alcohol intake and eCLE stratified by male sex and hiatal hernia, adjusting for clinical features and other potential confounders.
Alcohol intake (≥20 g/day) showed a marginally significant association with the incidence of eCLE in participants without hiatal hernia (0 vs. ≥20 g/day; odds ratio [OR], 1.62; 95% confidence interval [CI], 0.92–2.85, P = 0.09) but not in participants with hiatal hernia (0 vs. ≥20/day; OR, 0.99; 95% CI, 0.59–1.65; P = 0.95). Furthermore, alcohol intake (≥20 g/day) was significantly associated with the incidence of eCLE in male participants without hiatal hernia (0 vs. ≥20 g/day; OR, 1.98; 95% CI, 1.04–4.03; P = 0.04) but not in female participants without hiatal hernia (0 vs. ≥20 g/day; OR, 0.47; 95% CI, 0.03–2.37; P = 0.42).
The effect of alcohol intake on the incidence of eCLE might be associated with hiatal hernia status and male sex.
Barrett’s esophagus (BE) is a strong risk factor for the development of esophageal adenocarcinoma [1–4]. Some meta-analyses have shown that the pooled annual incidence of esophageal adenocarcinoma of BE was 0.19–0.33% [5, 6]. BE has malignant potential, and the determination of its epidemiology is important for preventing and screening for BE-derived esophageal adenocarcinoma.
In this large prospective, multicenter, cohort study, we found a significant association in the occurrence of eCLE between alcohol intake and status of hiatal hernia in male participants. Our data supported the hypothesis that the effect of alcohol consumption might be associated with hiatal hernia status and male sex. With the large number of cases, to the best of our knowledge, this is the first study to examine the association in the occurrence of eCLE among alcohol intake, status of hiatal hernia, and male sex.