Letter: incidence rates of Barrett's oesophagus and oesophageal adenocarcinoma in UK and the Netherlands - authors' reply.

Abstract

standard care for symptom relief in patients with Barrett’s oesophagus (BO). 3 In our study, 94% of the BO patients were treated with PPIs. Among BO patients, PPIs may decrease the risk of progression to high-grade dysplasia or oesophageal adenocarcinoma (OAC). 4 We do not know to what extent PPIs protect against new development of BO among patients with gastro-oesophageal reflux disease. 5 In the general population, the incidence of PPI use increased between 2000 and 2012 by 45% in the United Kingdom (UK) and 60% in the Netherlands. The incidence of BO levelled off as described both in the UK and Netherlands. The incidence of OAC among BO patients nevertheless increased more than 3-fold over the same time period. The design of our study and the use of PPIs by nearly all BO patients do not allow us to draw any conclusions as to what extent PPI use influenced the incidence of BO or OAC. It may well be that the increase in PPI use in the population contributed to the stabilisation of the incidence of BO and that the current PPI use by nearly all BO patients moderated the increase in OAC incidence. However, these hypotheses remain speculative.