Proton Pump Inhibitors Diminish Barrett's Esophagus Length: Our Experience

Gashi, Zaim; Bahtiri, Elton; Gashi, Arjeta; Sherifi, Fadil

doi:10.3889/oamjms.2018.232

Cited by 8 publications

(4 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Heartburn and esophageal reflux were observed in 8 of the 12 cases. Gashi et al [18] reported that BE shortened the maximum length and total circumference when proton pump inhibitors (PPIs) were administered for 2 years. As such, PPIs may be effective in patients with reflux esophagitis and GERD.…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma originating from long-segment Barrett's esophagus over 15 cm: a series of 3 cases

et al. 2020

View full text Add to dashboard Cite

Background Barrett's esophagus (BE) is characterized by presence of columnar epithelium in the lower esophageal mucosa, which originally comprises stratified squamous epithelium. Gastroesophageal reflux disease causes BE and BE adenocarcinoma (BEAC); further, the incidence of BEAC is increasing, especially in developed countries. Long-segment BE (LSBE) has a particularly high carcinogenic potential and necessitates treatment, surveillance, and prevention. Case presentation Herein, we report three cases of BEAC originating from LSBE larger than 15 cm. All three patients underwent surgery for the diagnosis of BEAC. A 66-year-old man with advanced esophageal cancer underwent neoadjuvant chemotherapy and subsequent subtotal esophagectomy. The postoperative pathological diagnosis was of poorly differentiated adenocarcinoma with lymph node metastasis (pT3 pN3 pM0 pStage III based on the Union for International Cancer Control TNM Classification 8th edition). Two years after the operation, the patient was diagnosed with recurrence around the celiac artery and underwent chemotherapy. An 83-year-old woman with advanced esophageal cancer underwent subtotal esophagectomy. The postoperative pathological diagnosis was of well-differentiated adenocarcinoma with supraclavicular lymph node metastasis (pT3 pN3 pM1 pStage IV). Two months after the operation, the patient was diagnosed with recurrence in the neck lymph nodes and underwent chemotherapy; however, she died. A 66-year-old man with early-stage esophageal cancer underwent subtotal esophagectomy. A superficial early cancerous lesion was seen over BE. The postoperative pathological diagnosis was of well-differentiated adenocarcinoma without lymph node metastasis (pT1a pN0 pM0 pStage 0). The patient was found to be alive and recurrence-free 3 months after the operation. Conclusions BEAC might show good prognosis if detected and treated early. Extremely LSBE is associated with a high incidence of BEAC; therefore, early detection and treatment with close surveillance is essential.

show abstract

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma originating from long-segment Barrett's esophagus over 15 cm: a series of 3 cases

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Acid-suppressive therapy during the early stages of BE or ablative surgery and acid-suppressive therapy at advanced stages are the only recommendations for medical management of BE, although their efficacy in preventing EA remains questionable. Acid-suppressive therapy and anti-reflux surgery reduce exposure of the esophagus to acidic contents of the stomach (Gore et al, 1993;Peters et al, 1999;Weinstein, 2002;El-Serag et al, 2004;Gashi et al, 2018;Tan et al, 2018). Although, in most cases, the change in length of the BE segment is reportedly uncommon, the acid suppression prevents disease progression during these early stages of BE.…”

Section: Discussionmentioning

confidence: 99%

Barrett’s Epithelium to Esophageal Adenocarcinoma: Is There a “Point of No Return”?

et al. 2021

View full text Add to dashboard Cite

Background: Esophageal adenocarcinoma (EA) arises from Barrett’s epithelium (BE), and chronic gastroesophageal reflux disease is considered the strongest risk factor for disease progression. All BE patients undergo acid suppressive therapy, surveillance, and BE removal by surgery or endoscopic ablation, yet the incidence of EAC continues to increase. Despite the known side effects and mortality, the one-size-fits-all approach is the standard clinical management as there are no reliable methods for risk stratification.Methods: Paired-end Illumina NextSeq500 RNA sequencing was performed on total RNA extracted from 20-week intervals (0, 20, 40, and 60 W) of an in vitro BE carcinogenesis (BEC) model to construct time series global gene expression patterns (GEPs). The cells from two strategic time points (20 and 40 W) based on the GEPs were grown for another 20 weeks, with and without further acid and bile salt (ABS) stimulation, and the recurrent neoplastic cell phenotypes were evaluated.Results: Hierarchical clustering of 866 genes with ≥ twofold change in transcript levels across the four time points revealed maximum variation between the BEC20W and BEC40W cells. Enrichment analysis confirmed that the genes altered ≥ twofold during this window period associated with carcinogenesis and malignancy. Intriguingly, the BEC20W cells required further ABS exposure to gain neoplastic changes, but the BEC40W cells progressed to malignant transformation after 20 weeks even in the absence of additional ABS.Discussion: The transcriptomic gene expression patterns in the BEC model demonstrate evidence of a clear threshold in the progression of BE to malignancy. Catastrophic transcriptomic changes during a window period culminate in the commitment of the BE cells to a “point of no return,” and removal of ABS is not effective in preventing their malignant transformation. Discerning this “point of no return” during BE surveillance by tracking the GEPs has the potential to evaluate risk of BE progression and enable personalized clinical management.

show abstract

“…Data on the effects of PPI treatment on esophageal and gastric mucosal inflammation in SSc patients are heterogeneous. PPI treatment with maximal doses (lansoprazole 2 × 30 mg or pantoprazole 2 × 40 mg) is useful for long-term safety and reduces the length of Barrett esophagus (29). Some other reports suggested that patients with SSc should be encouraged to receive early and long-term PPI treatment (14,19).…”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal involvement in systemic sclerosis: Findings in a real‑life setting

et al. 2019

View full text Add to dashboard Cite

Gastrointestinal tract involvement is the most common visceral affectation in systemic sclerosis (SSc), but the manifestations may vary in extension and severity. Endoscopic and histopathological gastroesophageal findings were investigated in patients with SSc. A total of 79 consecutive patients with definite SSc were enrolled in a cross sectional study. Clinical data were collected, upper gastrointestinal endoscopy and biopsies from gastric mucosa were performed in all cases. Fifty-seven (72.1%) out of 79 SSc patients had gastroesophageal symptoms. The most frequent were dysphagia, present in 33 (41.7%) and gastroesophageal reflux symptoms in 23 (29.1%) patients. Out of the 79 patients, 22 were asymptomatic, but in 16 esophageal and gastric mucosa changes were endoscopically detected. Reflux esophagitis was found in 39 (49.3%) patients. The presence of esophageal manifestations was not related to the disease duration or with its other variables. Signs of gastritis were endoscopically described in 47 (59.4%) and confirmed on histopathologic examinations in 45 patients. In 31 patients without any endoscopic changes, 18 (22.7%) showed signs of gastritis on histopathologic examination. No significant statistical differences were found between symptomatic and asymptomatic patients or between those with limited cutaneous SSc and those with diffuse cutaneous SSc in terms of clinical, endoscopic or histopathological findings, except the higher proportion of hiatal hernia in symptomatic patients. The results of this study might suggest that upper gastrointestinal endoscopy should be performed during the early stage of the disease and then periodically in patients diagnosed with SSc, even in the absence of typical symptoms.

show abstract

Proton Pump Inhibitors Diminish Barrett's Esophagus Length: Our Experience

Cited by 8 publications

References 15 publications

Adenocarcinoma originating from long-segment Barrett's esophagus over 15 cm: a series of 3 cases

Adenocarcinoma originating from long-segment Barrett's esophagus over 15 cm: a series of 3 cases

Barrett’s Epithelium to Esophageal Adenocarcinoma: Is There a “Point of No Return”?

Upper gastrointestinal involvement in systemic sclerosis: Findings in a real‑life setting

Contact Info

Product

Resources

About