PPIs FOR BARRETT'S ESOPHAGUS

NEW YORK (Reuters Health) Jan 01 - Proton pump inhibitors (PPIs) can reduce the risk of high-grade dysplasia and neoplasia in patients with Barrett's esophagus, according to a new retrospective study.

On the other hand, patients who took non-steroidal anti-inflammatory drugs (NSAIDs) had only a non-statistically significant reduction in risk, and statins did not show any effect, Dr. Dang M. Nguyen of the Michael E. DeBakey Veterans Affairs Medical Center in Houston and his colleagues found.

Barrett's esophagus patients are at 30- to 125-fold greater risk of esophageal adenocarcinoma than the general population, Dr. Nguyen and his team note in the December issue of Clinical Gastroenterology and Hepatology.

Researchers have suggested that suppressing acid to limit esophageal inflammation could prevent neoplasia, because of the link between chronic inflammation and cancer. That means that PPIs and NSAIDs could be protective. And other studies have found that statins inhibit proliferation and induce apoptosis in esophageal carcinoma cells.

However, there are few data on the effectiveness of various medications. To investigate, the researchers looked at 344 patients diagnosed with Barrett's esophagus between 1982 and 2004. Mean follow-up was 7.6 years, and totaled 2,620 patient-years. During that time, 33 of the study participants developed high-grade dysplasia or esophageal adenocarcinoma.

After being diagnosed with Barrett's esophagus, 67.2% of patients had been prescribed PPIs (mean duration of use, 5.1 years); 51% were prescribed an NSAID or aspirin (3.6 years); and 25.3% were prescribed statins (2.8 years).

After adjusting for gender, age at Barrett's esophagus diagnosis, and Barrett's esophagus length, patients who had filled their PPI prescriptions were at 61% lower risk of high-grade dysplasia or esophageal adenocarcinoma.

Patients who had filled at least one NSAID or aspirin prescription were 44% less likely to develop dysplasia or neoplasia, but that risk reduction was not statistically significant. There was no association between statins and dysplasia or neoplasia risk.

"This cohort study suggests that PPI therapy may reduce the incidence of high-grade dysplasia or esophageal carcinoma in patients with Barrett's esophagus," Dr. Nguyen and his team write. "NSAIDs/aspirin may also have a role as chemopreventive agents in Barrett's esophagus."

Evidence from this and other studies supports the use of acid-suppressing drugs to treat symptoms in Barrett's esophagus patients, but does not warrant "high-dose PPI therapy beyond that needed for symptom relief and mucosal healing," Dr. Douglas A. Corley of Kaiser Permanente in San Francisco writes in an accompanying editorial.

While aspirin use is supported for patients who have other indications for antiplatelet therapy, he adds, there is insufficient evidence to support its use in Barrett's esophagus patients who are not at increased risk of cardiovascular disease.

Clin Gastroenterol Hepatol 2009;7:1266-1268,1299-1304.