Thursday, December 3, 2015
Proton pump inhibitor use may not prevent cancer in Barrett's esophagus
In patients with Barrett's oesophagus, we found no evidence of a protective effect from PPI on the development of OAC or HGD. In fact, we observed an increased risk for developing high-grade dysplasia and adenocarcinoma in the oesophagus with long-term PPI usage. This association can partly be due to bias associated to symptom driven PPI intake. Until the results from future studies can further elucidate the association, PPIs should be restricted to symptom control according to current guidelines. Hence, PPI may not protect against malignant progression in BO patients and in selected high-risk patients, clinicians may consider adding or replacing long-term medical treatment with other modalities.
Barrett’s esophagus (BE) is a condition in which the stratified squamous epithelium (SSE) of the distal esophagus undergoes intestinal metaplasia (transformation to columnar epithelium), which predisposes the epithelium to esophageal adenocarcinoma (EAC). The etiologic consensus for BE, remains a matter of debate; however, strong association with chronic gastroesophageal reflux disease (GERD) has been documented. An accurate representation of the prevalence for BE is still not clear, most likely due to a lack of protocol for screening. The alarming increase of EAC by 600% for the past 25 years suggests that BE has increased as well, as the latter represents the main risk factor for EAC. This emphasizes the importance of better understanding the causal process leading to intestinal metaplasia (BE) and suggests that a possible re-evaluation of the current protocol for the management and treatment of GERD and BE may be beneficial.