PMID- 15447744
OWN - NLM
STAT- MEDLINE
DCOM- 20041202
LR  - 20131121
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 99
IP  - 10
DP  - 2004 Oct
TI  - Proton pump inhibitors are associated with reduced incidence of dysplasia in 
      Barrett's esophagus.
PG  - 1877-83
AB  - BACKGROUND AND AIMS: Esophageal acid exposure is important in the pathogenesis of 
      Barrett's esophagus (BE), and possibly in the progression of BE to dysplasia and 
      carcinoma. The aim of this study is to compare the development of dysplasia in BE 
      patients treated with or without proton pump inhibitor (PPI) or histamine 
      2-receptor antagonist (H2RA). METHODS: We analyzed prospectively collected data 
      by a single endoscopist on patients with BE in a VA (Veterans Affairs) setting 
      over a 20-yr time period (1981-2000). A pathologist used standard criteria to 
      diagnose BE/dysplasia. Pharmacy information after 1994 was retrieved from a 
      computerized database, and from research files for the period before that. The 
      receipt and the duration of H2RA and/or PPI use was compared between those with 
      and without dysplasia. The incidence of dysplasia was examined in a Kaplan-Meier 
      survival analysis stratified by PPI treatment status, and the risk of dysplasia 
      was examined in a Cox multiple regression analysis controlling for demographic 
      features, length of BE, and the year of BE diagnosis. RESULTS: We analyzed data 
      for 236 unique veteran patients with a mean age at BE diagnosis of 61.5 yr, 86% 
      Caucasian, and 98% male. During 1,170 patient-yr of follow-up, 56 patients 
      developed dysplasia giving an annual incidence rate of 4.7%. Of those, 14 had 
      high-grade dysplasia. The cumulative incidence of dysplasia was significantly 
      lower among patients who received PPI after BE diagnosis than in those who 
      received no therapy or H2RA; log rank test (p < 0.001). Furthermore, among those 
      on PPIs, a longer duration of use was associated with less frequent occurrence of 
      dysplasia. In multivariate analysis, the use of PPI after BE diagnosis was 
      independently associated with reduced risk of dysplasia, hazards ratio: 0.25 (95% 
      CI 0.13-0.47), p < 0.0001. Longer segments of BE and Caucasian race were other 
      independent risk factors for developing dysplasia. In general, similar findings 
      were observed when only cases with high-grade dysplasia were analyzed. 
      CONCLUSIONS: These results indicate that PPI therapy is associated with a 
      significant reduction in the risk of developing dysplasia in patients with BE. 
      However, more studies are required to confirm this finding.
FAU - El-Serag, Hashem B
AU  - El-Serag HB
AD  - Sections of Gastroenterology and Health Services Research, The Houston Center for 
      Quality of Care and Utilization Studies, 2002 Holcombe Boulevard (152), Houston, 
      TX 77030, USA.
FAU - Aguirre, Thomas V
AU  - Aguirre TV
FAU - Davis, Stephanie
AU  - Davis S
FAU - Kuebeler, Mark
AU  - Kuebeler M
FAU - Bhattacharyya, Achyut
AU  - Bhattacharyya A
FAU - Sampliner, Richard E
AU  - Sampliner RE
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - Am J Gastroenterol. 2004 Oct;99(10):1884-6. PMID: 15447745
CIN - Am J Gastroenterol. 2005 Apr;100(4):978-9. PMID: 15784046
MH  - Barrett Esophagus/*complications
MH  - Esophageal Neoplasms/*epidemiology/*prevention & control
MH  - Esophagus/*pathology
MH  - Female
MH  - Follow-Up Studies
MH  - Histamine H2 Antagonists/*therapeutic use
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - *Proton Pump Inhibitors
MH  - Retrospective Studies
EDAT- 2004/09/28 05:00
MHDA- 2004/12/16 09:00
CRDT- 2004/09/28 05:00
PHST- 2004/09/28 05:00 [pubmed]
PHST- 2004/12/16 09:00 [medline]
PHST- 2004/09/28 05:00 [entrez]
AID - AJG30228 [pii]
AID - 10.1111/j.1572-0241.2004.30228.x [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2004 Oct;99(10):1877-83. doi: 
      10.1111/j.1572-0241.2004.30228.x.