Occupational Exposure and the Risk of Barrett's Esophagus: A Case-Control Study

Case-control studies in the United States and Europe have linked occupational exposure to volatile sulfur compounds, solvents, and pesticide to increased risk of esophageal adenocarcinoma. However, the association between occupational exposures and the risk of Barrett's esophagus (BE) is unclear given the absence of studies in this area. This is a case-control study in patients undergoing endoscopy who were either referred directly or were eligible for screening colonoscopy and recruited from primary care clinics. All participants completed a survey on (1) self-reported occupational exposures to asbestos, metal dust, organic solvents, and pesticides, and (2) self reported longest held job and job-related activities. The latter were assigned by an industrial hygienist who was blinded to the case and control status into one of 99 standard occupational categories used by the US Department of Labor. Each occupational category was then assigned an expected level of exposure to the same four classes of agents in addition to radiation. We compared the self-reported exposure and the expected occupational exposure based on the self-reported occupation between cases with definitive BE and controls without BE. We examined the associations adjusting for age, sex, race, and patient recruitment source in a multivariable logistic regression analysis. We examined 226 cases of definitive BE and 1,424 controls without BE. There was a greater proportion of patients with self-reported asbestos exposure in cases than controls (16.2 % vs. 12.0 %; p = 0.08) but no significant differences in metal dust, organic solvents, or pesticides. The multivariate model did not show an independent association between self-reported asbestos exposure and BE. For the calculated occupational exposure, there were no significant differences between cases and controls for asbestos (29.6 % vs. 27.5 %; p = 0.5), metal dust, organic solvents, pesticides, or radiation exposure. Among commonly reported occupation, there were significantly greater proportion of retail sales workers in BE cases than controls (10.8 % vs. 4.9 %; p = 0.01). Exposure to asbestos and sedentary jobs may be risk factors for Barrett's esophagus. Further studies are needed to confirm this finding.