Do PPIs Protect Against Dysplasia, Cancer in Barrett's Esophagus?
In patients with Barrett's esophagus, use of proton pump inhibitors (PPIs) did not lead to dysplasia- or cancer-protective effects.
The association between PPIs and esophageal adenocarcinoma in patients with Barrett's esophagus have been debated. To further explore this connection, researchers from the Ministry of Health in China performed a systematic review and meta-analysis of the risk of esophageal adenocarcinoma or high-grade dysplasia with PPIs in these specific patients.
Five cohort and four case-control studies, including 5,712 patients with Barrett's esophagus were identified for the review. Findings from the meta-analysis showed PPIs had no association with the risk of esophageal adenocarcinoma and/or high-grade dysplasia in patients with Barrett's esophagus (unadjusted odds ratio [OR] 0.43, 95% CI: 0.17–1.08). In addition, no significant trend toward protection against esophageal adenocarcinoma or high-grade dysplasia with PPI use for >2–3 years (OR 0.91, 95% CI: 0.25–3.31) was seen when compared to <2–3 years (OR 0.91, 95% CI: 0.40–2.07). Study authors also noted "considerable heterogeneity between studies."
Overall, no protective effects against dysplasia or adenocarcinoma were seen with PPI use for patients with Barrett's esophagus. Healthcare providers who discuss possible chemopreventive effects of PPIs should be aware that such effects have not been validated with statistical significance, researchers concluded.
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