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Acid Suppressors Reduce Risk for Esophageal Adenocarcinoma in BE
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Patients with Barrett’s esophagus who took proton pump inhibitors or histamine-2 receptor antagonists had a lower risk for developing esophageal adenocarcinoma, according to research published in Alimentary Pharmacology & Therapeutics.
Mimi C. Tan, MD, of the section of gastroenterology and hepatology at Baylor College of Medicine, and colleagues wrote that these acid suppressors helped prevent inflammation caused by stomach acid and bile.
“Chronic inflammation from GERD-related acid and bile exposure leads to [BE] and [esophageal adenocarcinoma], possibly through increased cyclooxygenase (COX)-2 expression, which inhibits apoptosis and increases cell proliferation,” they wrote. “PPIs and H2Ras decrease [esophageal] acid and bile exposure and could have a role in mucosal healing and blocking the inflammation to neoplasia cascade.”
Tan and colleagues conducted a nested case-control study of male veterans diagnosed with BE to determine the independent effects of PPIs and H2PAs on the patients’ risk for esophageal adenocarcinoma. Cases with incident carcinoma were matched by incidence density sampling on birth year with patients with BE and no adenocarcinoma diagnosis. Investigators identified prescription medication use for 1 year prior to BE diagnosis, as well as 3 months prior to carcinoma diagnosis.
Tan and colleagues found that the cases (n = 300) were less likely than controls (n = 798) to use PPIs (90% vs. 94.5%; P = .01) and H2RAs (19.7% vs. 25.7%; P = .04).
Additionally, they found that PPIs were associated with a 41% lower risk for esophageal adenocarcinoma (OR = 0.59; 95% CI, 0.35–0.99) and H2RA use was associated with a 30% lower risk (OR = 0.7; 95% CI, 0.5–0.99)
Tan and colleagues suggested that future studies are needed to confirm the chemopreventive effect of these acid suppressors.
“These effects remained when adjusted for other potentially chemopreventive agents such as statins, aspirin, and NSAIDs, and on mutual adjustment,” they wrote. “We found especially low risk of [esophageal adenocarcinoma] in Barrett's patients using highdose PPIs and H2Ras.” - by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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