Proton pump inhibitor use may not prevent high‐grade dysplasia and oesophageal adenocarcinoma in Barrett's oesophagus: a nationwide study of 9883 patients

Abstract

SUMMARY BackgroundProton pump inhibitors (PPI) may potentially modify and decrease the risk for development of oesophageal adenocarcinoma in Barrett's oesophagus (BO).

Chemoprevention in Barrett’s Esophagus

“…113 Contrary to these results, in a recent Danish study of 9883 patients with BE, a high adherence to PPI use was associated with increased relative risk (RR) of developing high-grade dysplasia and cancer (RR 3.4, 95% CI 1.1-10.5). 114 A meta-analysis conducted by Singh and colleagues 115 demonstrated a 71% risk reduction in development of EAC and high-grade dysplasia in patients who were on PPIs for more than 2 to 3 years, whereas patients who received less than 2 years of therapy did not seem to benefit much from PPI use. Congruent with these observations, small clinical trials addressed the question of whether profound acid suppression can have chemopreventive potential in Barrett's mucosa.…”

The Effect of Proton Pump Inhibitors on Barrett’s Esophagus

“…For example, a recent, nationwide study of patients with Barrett's esophagus in Denmark examined PPI use and the risk of developing dysplasia and cancer. 33 Among 9883 patients with Barrett's esophagus, 140 developed high-grade dysplasia and/or cancer during a median follow-up period of 10.2 years. Patients who had high adherence to the use of PPIs had a significantly increased relative risk of developing high-grade dysplasia and cancer (relative risk, 3.4; 95% CI, 1.1-10.5), whereas the relative risk was increased, but not significantly, in the low-adherence PPI users (relative risk, 2.2; 95% CI, 0.7-6.7).…”

Barrett’s Esophagus: Diagnosis and Management

“…A recent longitudinal study from the Netherlands demonstrated a 75 % reduction in the risk of dysplastic progression in patients compliant with PPI therapy [ 80 ]. In contrast, a large populationbased study demonstrated no benefi t for PPI therapy in patients with Barrett's and possibly an increased risk of advanced disease [ 81 ]. For patients with symptomatic refl ux, there is clearly a role for diet and lifestyle modifi cation and antacid therapy for symptom control.…”