Lifestyle interventions can reduce the risk of Barrett’s esophagus: a systematic review and meta‐analysis of 62 studies involving 250,157 participants

Background Barrett's esophagus (BE) is a well‐established risk factor for esophageal adenocarcinoma. Our objective was to investigate the effectiveness of lifestyle interventions on BE risk. Methods We searched PubMed, Embase, and Web of Science up to 30 September 2020. The summary relative risks (RRs) and 95% confidence intervals (CIs) for the highest versus lowest categories of exposure were assessed. Analyses of subgroup, dose–response, sensitivity, and publication bias were conducted. Results Sixty‐two studies were included that involved more than 250,157 participants and 22,608 cases. Seven lifestyle factors were investigated: smoking, alcohol, body mass index (BMI), physical activity, sleep time, medication, and diet. We observed statistically significant increased BE risks for smoking (RR = 1.35, 95% CI = 1.16–1.57), alcohol intake (RR = 1.23, 95% CI = 1.13–1.34), body fatness (RR = 1.08, 95% CI = 1.03–1.13), less sleep time (RR = 1.76, 95% CI = 1.24–2.49), and proton pump inhibitors use (RR = 1.64, 95% CI = 1.17–2.29). Reduced risks of BE were found for aspirin (RR = 0.70, 95% CI = 0.58–0.84) and the intake of vitamin C (RR = 0.59, 95% CI = 0.44–0.80), folate (RR = 0.47, 95% CI = 0.31–0.71), and fiber (RR = 0.95, 95% CI = 0.93–0.97). The quality of most included studies was high and the subgroup analysis according to the quality score showed significant results (p
We conducted a large meta‐analysis based on sufficient evidence and a quantitative synthesis of the eligible data published up to 30 September 2020, to investigate the effectiveness of lifestyle interventions on Barrett's esophagus risk. In this meta‐analysis of 62 studies that involved more than 250,000 participants and 22,000 cases, we found that smoking, alcohol intake, high levels of body fatness, and less sleep time are associated with Barrett's esophagus risk. There are statistically significant reduced risks of Barrett's esophagus with aspirin use and vitamin C intake, folate, and dietary fiber. In a word, these findings strengthen our understanding of the potential mechanisms of Barrett's esophagus development and highlight awareness that lifestyle intervention could reduce the risks of Barrett's esophagus and, consequently, esophageal adenocarcinoma.