Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis

Singh, Siddharth; Garg, Sushil Kumar; Singh, Preet Paul; Iyer, Prasad G.; El–Serag, Hashem B.

doi:10.1136/gutjnl-2013-305997

Cited by 257 publications

(186 citation statements)

References 43 publications

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“…A metaanalysis based on 7 studies with 2,813 patients demonstrated a 71% reduced risk of HGD and/or EAC with PPI users (OR 0.3, 95% CI 0.1-0.8). No signifi cant eff ect was shown for H 2 RA usage in two studies ( 57 ). In another meta-analysis of 9 observational studies of 5,446 participants (605 with HGD or EAC), usage of cyclooxygenase inhibitors, aspirin, and nonaspirin cyclooxygenase inhibitors was associated with reduced risk for HGD and EAC independent of duration of therapy ( 58 ).…”

Section: Summary Of Evidencementioning

confidence: 96%

“…However, even in patients without refl ux symptoms, in whom BE is incidentally found during evaluation of other symptoms and/or signs, the use of PPIs deserves consideration. Several cohort studies now suggest that subjects with BE maintained on PPI therapy have a decreased risk of progression to neoplastic BE compared with those with either no acid suppressive therapy or those maintained on H 2 RA therapy ( 57,(137)(138)(139). In addition, the risk profi le of these medications is favorable in most patients, and the cost of this class of drugs has diminished substantially in recent years because of the availability of generic forms of the medications.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…In addition, the risk profi le of these medications is favorable in most patients, and the cost of this class of drugs has diminished substantially in recent years because of the availability of generic forms of the medications. Th ese factors, combined with the theoretical consideration that the same infl ammation that may be in part be responsible for pathogenesis of BE may also promote progression of BE, make the use of PPIs in this patient population appear justifi ed, even in those without GERD symptoms ( 57 ). Given the low probability of a randomized study of PPI use in BE, decisions regarding this intervention will likely rely on these retrospective data and expert opinion.…”

Section: Summary Of Evidencementioning

confidence: 99%

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ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 96%

Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

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ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

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1,356

1,412

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“…For this reason, it is recommended that patients with BE should receive proton pump inhibitors (PPI) as part of the therapy. Moreover, several studies have shown that patients on PPI's have a lower risk of neoplastic progression compared to patients without acid suppressive therapy (52,53).…”

Section: Management and Treatment Of Bementioning

confidence: 99%

Optimizing the diagnosis and therapy of Barrett’s esophagus

2017

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“…2,3 Yet, once BO is installed, PPIs have been associated with a significant decrease in highgrade dysplasia and OAC arising from BO. 4,5 Second, Masclee et al outline that, in contrast to BO, the OAC incidence rate continued to increase until now, which may reflect the long lag time between BO and high-grade dysplasia and OAC. Another hypothesis may be raised: as no evidence of BO is found in most cases of incident diagnoses of OAC, 6,7 at least part of these might arise from high-grade dysplasia developed in specific intestinal metaplasia in the gastric cardia, at the anatomical gastro-oesophageal junction (GOJ) and without evidence of classical or short-segment BO.…”

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confidence: 99%

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

Matuchansky

2014

Aliment Pharmacol Ther

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SIRS, I read with great interest the article by Masclee et al.1 who showed, in a dynamic population-based retrospective cohort study in the UK and the Netherlands that the incidence rates of Barrett's oesophagus (BO) increased from 2000 to 2003, but levelled off thereafter. I have two main concerns regarding their article. First, the relevant medical information, in the population-based registries which served as data sources, included drug prescriptions and/or use. It would have been worth knowing the yearly incidence rates, throughout the study period, of prescriptions [particularly of proton pump inhibitors (PPIs)], as compared with BO and oesophageal adenocarcinoma (OAC) incidence rates. Indeed, despite the strong rationale for the use of PPIs in BO, many clinical trials using PPIs did not show relevant BO regression.2, 3 Yet, once BO is installed, PPIs have been associated with a significant decrease in highgrade dysplasia and OAC arising from BO. 4, 5Second, Masclee et al. outline that, in contrast to BO, the OAC incidence rate continued to increase until now, which may reflect the long lag time between BO and high-grade dysplasia and OAC. Another hypothesis may be raised: as no evidence of BO is found in most cases of incident diagnoses of OAC,6,7 at least part of these might arise from high-grade dysplasia developed in specific intestinal metaplasia in the gastric cardia, at the anatomical gastro-oesophageal junction (GOJ) and without evidence of classical or short-segment BO.Intestinal metaplasia in the GOJ region may comprise two distinct entities: short-segment BO (specific intestinal metaplasia in the distal oesophagus), and metaplastic gastric carditis. 8 The possible pre-malignant role of the latter has been minimised, 8 but prospective studies separating these two entities are lacking. Carditis and intestinal metaplasia of the GOJ have indeed been considered as early histological indicators of gastro-oesophageal reflux disease.6, 9

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Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis

Cited by 257 publications

References 43 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Optimizing the diagnosis and therapy of Barrett’s esophagus

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

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