Acid suppression increases rates of Barrett’s esophagus and esophageal injury in the presence of duodenal reflux

Nasr, Ayman; Dillon, Marcus L.; Conlon, Susan; Downey, Paul; Chen, Gang; Ireland, Adrian P.; Leen, Eamon; Bouchier‐Hayes, David; Walsh, T. N.

doi:10.1016/j.surg.2011.08.021

Cited by 21 publications

(19 citation statements)

References 47 publications

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“…21,22 Therefore, R-Y is being increasingly used to perform in distal gastrectomy to prevent DGR and gastro-esophageal reflux. 23,24 From the above-mentioned details, we developed PRG with the advantage of both methods of B-I and R-Y and have already demonstrated the short-term results that our PRG is superior to the conventional B-I in preventing DGR. 12 In this study, the PRG for gastric cancer seems to be effective for a long time; further robust clinical studies and the collection of large-scale data are still required.…”

Section: Discussionmentioning

confidence: 93%

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction

Hoya

Taki

Watanabe

et al. 2016

Journal of Gastrointestinal Surgery

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Section: Discussionmentioning

confidence: 93%

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction

Hoya

Taki

Watanabe

et al. 2016

Journal of Gastrointestinal Surgery

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“…Therefore, it may be the severity of reflux that predisposes to cancer, rather than the usage of PPIs per se . However, in contravention with this hypothesis, the increased use of PPIs (introduced in the late 1980s [35]), is associated with the increasing incidence of EAC [36, 37]. Concerns that PPI-induced hypergastrinaemia may increase the risk of adenocarcinoma development have also been expressed [38].…”

Section: Discussionmentioning

confidence: 99%

Proton Pump Inhibitors Do Not Reduce the Risk of Esophageal Adenocarcinoma in Patients with Barrett’s Esophagus: A Systematic Review and Meta-Analysis

Sun

Hong

et al. 2017

PLoS ONE

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ObjectivesProton pump inhibitors (PPIs) have been used for treatment of Barrett's esophagus (BE) for many years. However, the connection between PPIs and esophageal adenocarcinoma (EAC) in patients with BE has still been controversial. The current systematic review and meta-analysis was designed to evaluate the association between PPIs and the risk of EAC or high-grade dysplasia (HGD) in patients with BE.MethodsA systematic literature search of studies reporting the association between PPIs and the risk of EAC and/or HGD in patients with BE was conducted in PubMed, Embase, Web of Science and the Cochrane Library. Next, literature was screened using previously established criteria and relevant data were extracted from included studies. Finally, the software program Review Manage 5.2 was applied to aggregate data and analyze the results.ResultsNine observational studies, comprising five cohort and four case-control studies (including a total of 5712 patients with BE), were identified. Upon meta-analysis, PPIs were found to have no association with the risk of EAC and/or HGD in patients with BE (unadjusted OR 0.43, 95% CI 0.17–1.08). Analysis for duration response relationship revealed no significant trend toward protection against EAC or HGD with PPIs usage for >2~3 years (one study using 7-year cutoff) when compared to usage for shorter time periods (PPIs usage >2~3 years vs. <2~3 years: OR 0.91 (95% CI 0.25–3.31) vs. 0.91 (0.40–2.07)).There also was considerable heterogeneity between studies.ConclusionNo dysplasia- or cancer-protective effects of PPIs usage in patients with BE were identified by our analysis. Therefore, we conclude that clinicians who discuss the potential chemopreventive effects of PPIs with their patients, should be aware that such an effect, if exists, has not been proven with statistical significance.

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“…If the reflux contains a significant concentration of bile, this therapy is substantially less effective [8]. Nonetheless, according to some studies, the acid suppressing effect of PPI may on the contrary enhance the development of intestinal metaplasia and cellular proliferation in duodenogastroesophageal reflux leading to malignization of Barrett's mucosa [9]. Prokinetic drugs may to a certain extent aid stomach evacuation; however, an absolute effect cannot be expected.…”

Section: Discussionmentioning

confidence: 99%

The effect of laparoscopic fundoplication in therapy of Barrett's esophagus.

Aujeský¹,

Neoral²,

Vrba³

et al. 2014

Videosurgery and Other Miniinvasive Techniques

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IntroductionBarrett's esophagus is the most significant precancer of the esophagus. Its malignization gives rise to most adenocarcinomas of the esophagus. Therefore selection of adequate therapy for this precancerous condition is of the utmost importance.AimThe authors of the work addressed the question of whether effective therapy of reflux disease alone may halt the process of malignization of Barrett's mucosa or even cause its regression.Material and methodsThe analyzed set comprised 50 patients with Barrett's esophagus, who in 48 cases underwent laparoscopic fundoplication and in two cases underwent an indirect antireflux procedure in the form of gastric resection with a Roux-en-Y gastrojejunal anastomosis. The effect of the procedure was evaluated by comparing preoperative and postoperative endoscopic examinations, as well as histological analysis by biopsy taken from Barrett's mucosa.ResultsIn 19 patients (38%), Barrett's mucosa was not detected postoperatively. An improved finding in terms of disappearance of mucosal dysplasia was found in 8 (16%) patients. Findings remained unchanged in 18 (36%) patients. In 5 (10%) patients progression of the disease was discovered.ConclusionsA surgical antireflux procedure, primarily in the form of laparoscopic fundoplication, is considered an effective method for treating Barrett's esophagus up to the stage of mild dysplasia. If this therapy is unsuccessful, the method of choice is local therapy, either an endoscopic mucosectomy or radiofrequency ablation.

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Acid suppression increases rates of Barrett’s esophagus and esophageal injury in the presence of duodenal reflux

Cited by 21 publications

References 47 publications

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction

Proton Pump Inhibitors Do Not Reduce the Risk of Esophageal Adenocarcinoma in Patients with Barrett’s Esophagus: A Systematic Review and Meta-Analysis

The effect of laparoscopic fundoplication in therapy of Barrett's esophagus.

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