The presence on diagnosis of endoscopic macroscopic markers indicates a high-risk group for Barrett's esophagus.
Dr Hillman and colleagues from Australia determined whether proton pump inhibitor (PPI) therapy prior to diagnosis of Barrett's esophagus influences markers for risk development of subsequent high-grade dysplasia/adenocarcinoma.
|14 patients developed adenocarcinoma during surveillance|
|Alimentary Pharmacology & Therapeutics|
The team underook a review of all patients with Barrett's esophagus entering a surveillance program.
The researchers assessed 502 patients diagnosed with Barrett's esophagus on diagnosis for endoscopic macroscopic markers or low-grade dysplasia.
Subsequent development of high-grade dysplasia/adenocarcinoma was documented.
The team determined the relationship between the initiation of proton pump inhibitor therapy prior to the diagnosis of Barrett's, and the presence of macroscopic markers or low-grade dysplasia at entry.
The researchers found that 14 patients developed high-grade dysplasia/adenocarcinoma during surveillance.
Patients who entered without prior proton pump inhibitor therapy were 3 times more likely to have a macroscopic marker or low-grade dysplasia than those patients already on a proton pump inhibitor.
Dr Hillmans' team concluded, "Use of proton pump inhibitor therapy prior to diagnosis of Barrett's esophagus significantly reduced the presence of markers used to stratify patient risk."
"Widespread use of proton pump inhibitors will confound surveillance strategies for patients with Barrett's esophagus based on entry characteristics but is justified because of the lower risk of neoplastic progression."