Esophageal acid exposure is a key factor in the pathogenesis of Barrett's esophagus (BE), and possibly in the progression of BE to dysplasia and carcinoma.
Researchers from Houston, Texas compared the development of dysplasia in BE patients treated with or without proton pump inhibitor (PPI) or histamine 2-receptor antagonist (H2RA).
In this prospective study, the research group analyzed data that had been collected by a single endoscopist on patients with BE in a VA (Veterans Affairs) setting over a 20-yr time period (1981-2000).
A pathologist used standard criteria to diagnose BE/dysplasia.
The researchers retrieved pharmacy information after 1994 from a computerized database, and from research files for the period before that.
|Longer segments of BE and Caucasian race are independent risk factors for developing dysplasia|
|American Journal of Gastroenterology|
The researchers compared the receipt and the duration of H2RA and/or PPI use in those patients with and without dysplasia.
The researchers examined the incidence of dysplasia in a Kaplan-Meier survival analysis stratified by PPI treatment status, and the risk of dysplasia was examined in a Cox multiple regression analysis controlling for demographic features, length of BE, and the year of BE diagnosis.
In total, the research group analyzed data for 236 unique veteran patients with a mean age at BE diagnosis of 61.5 yr, 86% Caucasian, and 98% male.
During 1,170 patient-yr of follow-up, 56 patients developed dysplasia giving an annual incidence rate of 4.7%. Of those, 14 had high-grade dysplasia.
The group found that the cumulative incidence of dysplasia was significantly lower among patients who received PPI after BE diagnosis than in those who received no therapy or H2RA; log rank test.
Furthermore, among those on PPIs, a longer duration of use was associated with less frequent occurrence of dysplasia.
Using multivariate analysis, the researchers found that the use of PPI after BE diagnosis was independently associated with reduced risk of dysplasia.
The research group also made the observation that longer segments of BE and Caucasian race were other independent risk factors for developing dysplasia.
In general, similar findings were observed when only cases with high-grade dysplasia were analyzed.