Table 1.

Associations between the 7 preventive targets and risk of EAC, evidence of preventive effects, and the level of evidence according to the Oxford Centre for Evidence-based Medicine

Etiologic factorRisk of EACPreventive measureBest available evidencePrevention of EACLevel of evidencea
Gastroesophageal reflux diseaseWeekly symptoms: OR, 4.92; 95% CI, 3.90–6.22 (15)Medication with PPIM-A of patients with BEPPI vs. no PPI: OR, 0.29; 95% CI, 0.12–0.79 (20)3a
Daily symptoms: OR, 7.40; 95% CI, 4.94–11.1 (15)Anti-reflux surgeryM-A of patients with BEAntireflux surgery vs. medication: IRR, 0.46; 95% CI, 0.20–1.08 (23)2a
ObesityBMI 25–30: RR, 1.71; 95% CI, 1.50–1.96 (25)Weight loss by obesity surgeryNot sufficient data
BMI ≥ 30: RR, 2.34; 95% CI, 1.95–2.81 (25)
BMI ≥ 40: OR, 3.65; 95% CI, 2.50–5.34 (26)
Tobacco smokingEver vs. never: OR, 2.08; 95% CI, 1.83–2.37 (34)Tobacco smoking cessationPooled analysis of 10 studiesTobacco smoking cessation < 10 y: OR, 0.82; 95% CI, 0.60–1.13 (34)3b
Tobacco smoking cessation ≥ 10 y: OR, 0.71; 95% CI, 0.56–0.89 (34)3b
H. pylori infectionCurrent infection: OR, 0.52; 95% CI, 0.37–0.73, (41) and OR, 0.59; 95% CI, 0.51–0.68 (42)H. pylori eradicationM-A of eradication and risk of GERD and erosive esophagitisEradication and risk of erosive GERD: OR, 1.17; 95 % CI, 0.94–1.45 (43)2a
Eradication and risk of GERD: OR, 0.84; 95% CI, 0.60–1.18 (44)
Eradication and risk of erosive esophagitis: OR, 0.97; 95% CI, 0.72–1.31 (44)
HRTMedication with HRTM-A of women receiving HRTEver vs. never: OR, 0.75; 95% CI, 0.58–0.98 (50)3a
NSAIDsMedication with NSAIDPooled analysis of 6 studiesDaily vs. never: OR, 0.56; 95% CI, 0.43–0.73 (57)3b
Occasional vs. never: OR, 0.66; 95% CI, 0.44–1.00 (57)3b
M-A of 8 RCTs 20-year follow-upDaily vs. placebo: HR, 0.36; 95% CI, 0.21–0.63 (58)1a
StatinsMedication with statinsM-A of patients with BEUsers vs. nonusers: OR, 0.59; 95% CI, 0.45–0.78 (61)3a
M-A of patients irrespective of BEUsers vs. nonusers: OR, 0.72; 95% CI, 0.60–0.86 (61)3a
  • Abbreviations: BE, Barrett esophagus; M-A, meta-analysis; RR, Rate ratio.

  • aLevel of Evidence according to the Oxford Centre for Evidence-based Medicine's levels of evidence; the level of evidence is graded: 1 (RCTs), 2 (cohort studies), 3 (case–control studies), 4 (case series), and 5 (expert opinions); grades 1 to 3 are also denoted as a (systematic review) or b (individual study). Refer to ref. 12.