Studies were excluded if they met any of the following criteria: 1 the full text of the article could not be obtained; 2 the necessary clinical characteristics of BE patients were insufficient, such as lack of the amount of alcohol consumption; 3 BE diagnosed only on endoscopic appearance and without histological confirmation. If a study provided separate RR estimates for men and women, we treated the RRs as two different studies. If a study contained several RR estimates, we took the RR reflecting the greatest extent of control for underlying confounders.
If a study applied different types of control, we choose inflammation control data preferentially and then endoscopic negative control, mixed control; population control was the last choice. In addition, adjusted RRs were selected in preference to non-adjusted RRs. All the data were examined by two independently reviewers Lin-Lin Ren and Ting-Ting Yan for eligibility and quality and divergences were resolved by a third reviewer Zhen-Hua Wang.
Pooled RRs for highest vs. If a study showed the exact gram of alcohol consumption or conversion method, we transferred the alcohol consumption as described. If a study did not provide the gram of alcohol, total amount of alcohol consumed was estimated at One drink was defined as Then we obtained the general RR estimates by pooling the separate RR using the inverse of the corresponding variance coefficient as weights.
The degree of heterogeneity across the studies was calculated via the Q statistic 33 , whose statistical significance was set at 0. If the significant heterogeneity was less than 0. Subgroup analyses were explored to identify the causes of heterogeneity. All analyses were performed with Stata version How to cite this article : Ren, L.
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Journal international du cancer , —, doi: NYU Langone gastroenterologists may recommend lifestyle changes in combination with medication or other treatments, such as endoscopic procedures. GERD occurs when the acidic contents of the stomach rise into the esophagus.
Avoiding trigger foods—such as chocolate, coffee, fried foods, peppermint, spicy foods, and carbonated beverages—can help reduce symptoms. These foods increase acid levels in the stomach.
Doctors also recommend eating multiple small, frequent meals instead of a few large ones. Authors of the study include: Ai Kubo, T. Levin, Gregory Rumore, Charles P. Quesenberry, Jr. Materials provided by Kaiser Permanente. Note: Content may be edited for style and length. Science News. Story Source: Materials provided by Kaiser Permanente. ScienceDaily, 7 March Kaiser Permanente. The realization of the relationship between the modifiable epidemiological factors and neoplastic progression in Barrett's esophagus would provide a more effective strategy for the cancer prevention in the future.
Alcohol consumption, which was related with the incidence of both the Barrett's esophagus and EAC, was considered to play a role in the progression from Barrett's esophagus to the EAC. However, inconsistent evidence exists regarding the effect of alcohol consumption on the neoplastic progression in Barrett's esophagus. In this meta-analysis, we found that alcohol consumption is not associated with progression of Barrett's esophagus.
This result supports the conclusions of several previous studies. In —, a prospective, multicenter cohort study including patients with Barrett's esophagus was conducted. When the subgroup analyses stratified by the study designs was conducted, the associations between alcohol consumption and Barrett's esophagus progression wasn't detected in neither case-control nor cohort studies. As we know, the cohort study design could avoid the potential recall bias and would provide more credible conclusions.
A consistent result is obtained in both the case-control and cohort studies and it suggests that the result of this meta-analysis is quite credible. However, the studies conducted in the Americas showed that alcohol drinking was a risk factor of the progression of Barrett's esophagus.
The geographical differences, the diet diversity and ethnic and genetic disparity are the possible reasons. Alcohol consumption, which was classified as beer, liquor and wine intake, might demonstrate different effect in the development of Barrett's esophagus.
The difference of the drinking habits in each region might cause the results. Besides, the relatively small number of studies included in the subgroup analyses 5 in the Americas and 1 in the Africa might lead to the instability of the conclusions. It suggests that alcohol might be not associated in any stage of the Barrett's esophagus progression.
To our best knowledge, this is the first meta-analysis involving the relationship between alcohol consumption and risk of development of Barrett's esophagus. There are some strengths of this work. In the literature search, a large number of subjects were evaluated for the detection of the effect of the neoplastic risk in Barrett's esophagus associated with alcohol drinking. Besides, through two independent methods, the publication bias wasn't significant.
These above results demonstrated that the conclusions of this meta-analysis were quite persuasive. Despite these advantages mentioned above, some limitations of the current meta-analysis should be acknowledged.
First, the definitions of the case groups were not uniformly defined. Both the patients without higher alcohol intake or ever alcohol intake were obtained as the controls in the included studies.
This would produce potential misclassification bias. While the subgroup analyses showed that no different results were detected and thus this might produce no serious problem. Secondly, even the categories of alcohol consumption are reported in some studies; however, the data were varied and broad. Thus, we were unable to determine the dose-response association between alcohol consumption and progression of Barrett's esophagus.
Third, it has been argued that because meta-analyses of observational studies may produce very precise, but spurious, results, a statistical combination of these data should not be the prominent component.
However, considering that as an etiology exploring nature of this study, the pooled results of the observational studies would also provide certain improvement of the knowledge of the neoplastic development.
The end, a combination of prognostic factors has been suggested to be required to define subgroups of patients at an increased risk of progression. However, the data of the included studies reported no sufficient data for an advanced research, which demonstrated the potential breakthrough. The forth, the understanding of the Barrett's esophagus has developed in the recent years. The old conception says that although several different kinds of columnar epithelium can be found in the lower esophagus, it is only specialized intestinal metaplasia SIM , distinguished by the presence of goblet cells, which increased the cancer risk.
However, nowadays recent studies revealed that cardiac-type mucosa, columnar lined esophagus without goblet cells, also have the posibility of cancer development. With the development of understanding of Barrett's esophagus, the older papers might provide results based on inaccurate definitions and thus the bias could not be ignored.
Advanced well-designed studies based on both endoscopic results and histocytology are wanted in the future. In conclusion, on the basis of epidemiologic evidence, we found that alcohol consumption was not a neoplastic risk in Barrett's esophagus. To get a more definitive conclusion, further pooled analyses with more complete raw data or prospective cohort studies with larger sample size, well controlled confounding factors and longer duration of follow-up are needed in this area.
The funnel plot of all the included studies. Evidence of publication bias for studies in this current meta-analysis wasn't noted in symmetrical funnel plot on visual inspection. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field.
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