Yao Haijuan, Wang Le, Li Hongyu, Xu Shixue, Bai Zhaohui, Wu Yanyan, Chen Hongxin, Goyal Hemant, Qi Xingshun
Department of Gastroenterology, General Hospital of Northern Theater Command (formerly called General Hospital of Shenyang Military Area), Shenyang, China.
Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, P.R. China.
Expert Rev Clin Pharmacol. 2022 Jan;15(1):79-88. doi: 10.1080/17512433.2022.2008909. Epub 2021 Nov 27.
BACKGROUND: Barrett's esophagus (BE) is an important risk factor for high-grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC). The effect of proton pump inhibitors (PPIs) on the chemoprevention of HGD and/or EAC arising from BE remains controversial. RESEARCH DESIGN AND METHODS: PubMed, EMBASE, and Cochrane Library databases were systematically searched. Risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by a random-effect model. Heterogeneity and its potential source were assessed. RESULTS: Fifteen studies with 26,291 BE patients were included. Meta-analysis of eight cohort studies showed that PPIs can significantly reduce the risk of HGD and/or EAC in BE patients (RR = 0.46; P < 0.001), but meta-analysis of six case-control studies showed no significant benefit of PPIs (OR = 0.64; P = 0.334). Heterogeneity was significant among both cohort and case-control studies, which might be attributed to the information sources of PPIs. There was no significant protective effect of high-dose PPIs on HGD and/or EAC in one RCT (RR = 0.84; P = 0.21), meta-analysis of two cohort studies (RR = 0.61; P = 0.28), or meta-analysis of two case-control studies (OR = 0.32; P = 0.08). CONCLUSIONS: Chemoprevention of HGD and/or EAC by PPIs may be considered in BE patients. However, there might not be further preventive effect of high-dose PPIs.
背景：巴雷特食管（BE）是高级别上皮内瘤变（HGD）和/或食管腺癌（EAC）的重要危险因素。质子泵抑制剂（PPI）对BE所致HGD和/或EAC的化学预防作用仍存在争议。 研究设计与方法：系统检索了PubMed、EMBASE和Cochrane图书馆数据库。采用随机效应模型汇总95%置信区间（CI）的风险比（RR）或比值比（OR）。评估异质性及其潜在来源。 结果：纳入了15项研究，共26291例BE患者。八项队列研究的荟萃分析表明，PPI可显著降低BE患者发生HGD和/或EAC的风险（RR = 0.46；P < 0.001），但六项病例对照研究的荟萃分析显示PPI无显著益处（OR = 0.64；P = 0.334）。队列研究和病例对照研究中的异质性均很显著，这可能归因于PPI的信息来源。一项随机对照试验（RR = 0.84；P = 0.21）、两项队列研究的荟萃分析（RR = 0.61；P = 0.28）或两项病例对照研究的荟萃分析（OR = 0.32；P = 0.08）中，高剂量PPI对HGD和/或EAC均无显著保护作用。 结论：BE患者可考虑采用PPI进行HGD和/或EAC的化学预防。然而，高剂量PPI可能没有进一步的预防效果。
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