Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
Clin Gastroenterol Hepatol. 2013 Apr;11(4):382-8. doi: 10.1016/j.cgh.2012.11.014. Epub 2012 Nov 28.
BACKGROUND & AIMS: Acid exposure contributes to the development of Barrett's esophagus (BE) and its progression toward esophageal adenocarcinoma. Patients with BE are frequently treated with acid suppressants, but it is unclear whether these prevent the development of BE-related cancer. We investigated whether acid suppression reduces the risk of neoplastic progression in patients with BE.
We performed a multicenter prospective cohort study of 540 patients with BE. We collected information on medication use at each surveillance visit, which was cross-checked with pharmacy records. Patients also completed a questionnaire about their use of over-the-counter medication. Incident cases of high-grade dysplasia and esophageal adenocarcinoma were identified during a median follow-up period of 5.2 years. Time-dependent Cox regression models were used to investigate the effect of acid suppression on the risk of neoplastic progression.
Forty patients (7%) developed high-grade dysplasia or esophageal adenocarcinoma during the follow-up period. Use of histamine-2 receptor antagonists did not affect the incidence of neoplastic progression. However, use of proton pump inhibitors (PPIs) at inclusion in the study or during the follow-up period reduced the risk of neoplastic progression (hazard ratio, 0.41; 95% confidence interval, 0.18-0.93 and hazard ratio, 0.21; 95% confidence interval, 0.07-0.66). Prolonged use of PPIs and good adherence were associated with an additional protective effect. The prevalence of esophagitis decreased during PPI use, but length of BE was not affected.
In a multicenter prospective cohort study, PPI use was associated with a reduced risk of neoplastic progression in patients with BE.
酸暴露会导致 Barrett 食管（BE）的发展及其向食管腺癌的进展。患有 BE 的患者经常接受酸抑制剂治疗，但尚不清楚这些治疗是否能预防 BE 相关癌症的发生。我们研究了酸抑制是否能降低 BE 患者发生肿瘤进展的风险。
我们对 540 例 BE 患者进行了一项多中心前瞻性队列研究。我们在每次随访时收集药物使用信息，并与药房记录进行交叉核对。患者还完成了一份关于他们使用非处方药的问卷。在中位随访 5.2 年期间，确定了高级别异型增生和食管腺癌的新发病例。采用时间依赖性 Cox 回归模型来研究酸抑制对肿瘤进展风险的影响。
在随访期间，有 40 例（7%）患者发生高级别异型增生或食管腺癌。使用组胺 2 受体拮抗剂不会影响肿瘤进展的发生率。然而，在研究纳入时或随访期间使用质子泵抑制剂（PPIs）可降低肿瘤进展的风险（风险比，0.41；95%置信区间，0.18-0.93 和风险比，0.21；95%置信区间，0.07-0.66）。长时间使用 PPI 和良好的依从性与额外的保护作用相关。在使用 PPI 期间，食管炎的患病率下降，但 BE 的长度没有受到影响。
在一项多中心前瞻性队列研究中，PPI 的使用与 BE 患者肿瘤进展风险降低相关。
