Kasiri Karamali, Sherwin Catherine M T, Rostamian Sahar, Heidari-Soureshjani Saeid
Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Pediatric Clinical Pharmacology and Toxicology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio.
Curr Ther Res Clin Exp. 2023 Jan 25;98:100692. doi: 10.1016/j.curtheres.2023.100692. eCollection 2023.
BACKGROUND: Esophageal cancer is a cancerous tumor that develops in the esophagus. It is the 10th most common cancer and has a low survival rate. Esophageal adenocarcinoma (EAC) is increasing in incidence globally. Those with EAC are affected by Barrett's esophagus metaplasia, which is attributed to genetic predisposition and is more common in men. Studies suggest that gastric acid suppressants, like proton pump inhibitors and histamine-2 receptor antagonists, have anticancer properties and reduce EAC. However, other research has suggested that they are not cancer-protective, and the use of antisecretory drugs is a risk factor for developing EAC. OBJECTIVE: This systematic review and meta-analysis investigated the properties and risk factors associated with using gastric acid suppressants in patients with EAC. METHODS: This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Information from selected articles, including the lead author's name, year of publication, study setting, sample size, and gender, was extracted and recorded into an Excel (Microsoft, Redmond, Washington) form. Statistical data included odds ratio, hazard ratio, and/or risk ratio, with a 95% CI associated with patients with EAC and receiving gastric acid suppressants. Data were compared with individuals not receiving treatment. Publication bias was assessed using Begg's and Egger's tests. Statistical analyzes used Stata 14.0 (Stata LLC, College Station, Texas). RESULTS: The initial electronic literature search retrieved 3761 titles/abstracts. Extensive screening selected 20 articles for analysis. Odds ratios associated with EAC in the individuals using gastric acid suppressants were 0.77 (95% CI, 0.49-1.22; = 0.274) and 0.67 (95% CI, 0.39-1.29; = 0.240) for proton pump inhibitors and 1.02 (95% CI, 0.44-2.36; = 0.967) for histamine-2 receptor antagonists. CONCLUSIONS: The results found that gastric acid suppressants do not have a protective role in EAC and are not risk factors. Future studies of confounding variables and risk factors are needed to understand what affects EAC development.
背景：食管癌是一种发生于食管的癌性肿瘤。它是全球第10大常见癌症，生存率较低。食管腺癌（EAC）的发病率在全球范围内呈上升趋势。患有EAC的患者会受到巴雷特食管化生的影响，这归因于遗传易感性，且在男性中更为常见。研究表明，胃酸抑制剂，如质子泵抑制剂和组胺-2受体拮抗剂，具有抗癌特性并能降低EAC的发病率。然而，其他研究表明它们并无防癌作用，且使用抗分泌药物是发生EAC的一个危险因素。 目的：本系统评价和荟萃分析研究了EAC患者使用胃酸抑制剂相关的特性和危险因素。 方法：本荟萃分析采用系统评价和荟萃分析的首选报告项目清单。从所选文章中提取包括第一作者姓名、发表年份、研究背景、样本量和性别等信息，并记录到Excel（微软公司，华盛顿州雷德蒙德）表格中。统计数据包括比值比、风险比和/或危险比，以及与EAC患者且接受胃酸抑制剂治疗相关的95%置信区间。将数据与未接受治疗的个体进行比较。使用Begg检验和Egger检验评估发表偏倚。统计分析使用Stata 14.0（Stata有限责任公司，德克萨斯州大学城）。 结果：最初的电子文献检索共获得3761个标题/摘要。经过广泛筛选，选择了20篇文章进行分析。使用质子泵抑制剂的个体中与EAC相关的比值比为0.77（95%置信区间，0.49 - 1.22；P = 0.274），使用组胺-2受体拮抗剂的个体中该比值比为0.67（95%置信区间，0.39 - 1.29；P = 0.240），而使用组胺-2受体拮抗剂的个体中该比值比为1.02（95%置信区间，0.44 - 2.36；P = 0.967）。 结论：结果发现胃酸抑制剂在EAC中没有保护作用，也不是危险因素。未来需要对混杂变量和危险因素进行研究，以了解哪些因素会影响EAC的发生发展。
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