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Acid-suppressive medications and risk of esophageal cancer in Barrett's

The most recent issue of Gut evaluates the association between acid-suppressive medications, and risk of esophageal adenocarcinoma or high-grade dysplasia in patients with Barrett's esophagus.

News image

Acid-suppressive medications, particularly proton pump inhibitors (PPIs), may decrease the risk of esophageal adenocarcinoma in patients with Barrett's esophagus.

Dr Siddharth Singh and colleagues from Minnesota, USA performed a systematic review with meta-analysis of studies evaluating the association between acid-suppressive medications, and risk of esophageal adenocarcinoma or high-grade dysplasia in patients with Barrett's esophagus.

The researchers performed a systematic search of multiple electronic databases and conference proceedings up to 2013 to identify studies reporting the association between use of acid-suppressive medications, and risk of esophageal adenocarcinoma and/or high-grade dysplasia in patients with Barrett's esophagus.

The team identified 7 observational studies.

PPI use was associated with a 71% reduction in risk of esophageal adenocarcinoma
Gut

On meta-analysis, the team found that PPI use was associated with a 71% reduction in risk of esophageal adenocarcinoma and/or high-grade dysplasia in patients with Barrett's esophagus.

There was a trend towards a dose–response relationship with PPI use for >2–3 years protective against esophageal adenocarcinoma or high-grade dysplasia.

Considerable heterogeneity was observed.

The team identified 2 studies that reported the association between H2RA use and risk of esophageal adenocarcinoma and/or high-grade dysplasia, and both studies did not show a significant effect.

Dr Singh's team concludes, "Based on meta-analysis of observational studies, the use of PPIs is associated with a decreased risk of esophageal adenocarcinoma and/or high-grade dysplasia in patients with Barrett's esophagus."

"None of the studies showed an increased risk of esophageal adenocarcinoma."

"PPI use should be considered in Barrett's esophagus, and chemopreventive trials of PPIs in patients with Barrett's esophagus are warranted."

Gut 2014;63:1229-1237
10 July 2014

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