Acid-suppressive Medications and Risk of Esophageal Adenocarcinoma in Patients With Barrett's Esophagus(Gut 2014;63:1229-1237).

Abstract

Barrett’s esophagus (BE), characterized by a metaplastic change in the esophageal mucosa from a squamous to columnar mucosa with intestinal metaplasia, is the dominant pre-malignant lesion associated with esophageal adenocarcinoma (EAC), and BE confers a 30–125 folds higher risk of EAC. Although acid-suppressive medications can be used as a chemopreventive strategy for patients with BE, their effect on the incidence of EAC has been controversial.1 Recently, Singh et al2 reported a systematic review and meta-analysis of all studies that had investigated the association between acid-suppressive medications and EAC/high-grade dysplasia (HGD) in patients with BE. In a meta-analysis of 7 studies (2813 patients with BE, 317 cases of EAC/HGD), proton pump inhibitors (PPIs) were associated with a 71% risk reduction in progression to EAC/HGD among patients with BE (adjusted odds ratio, 0.29; 95% confidence interval, 0.12–0.79). This PPI effect was duration-dependent; PPI use extending beyond 2–3 years after BE diagnosis was associated with a lower risk of EAC/HGD, whereas PPI use for a shorter period was not associated with a protective effect. In addition, the PPI effect was independent of the presence of erosive esophagitis or reflux symptoms or the concomitant use of other putative chemopreventive agents such as aspirin and statins. However, histamine receptor antagonists had no significant effect on EAC risk modification in patients with BE. Therefore, the authors suggested that PPI use should be considered as a chemopreventive method in patients with BE.