Study Supports Use of Proton Pump Inhibitors as Chemoprevention in Patients With Barrett's Esophagus

October 18, 2007 (Philadelphia) — Proton pump inhibitor (PPI) use reduces the risk for neoplasia in patients with Barrett's esophagus, according to a study presented here at the American College of Gastroenterology 2007 Annual Scientific Meeting and Postgraduate Course.
"Our data supports the use of PPIs as chemoprevention in patients with Barrett's esophagus," lead investigator John Kuczynski, MD, chief medical resident at the Southern Arizona Veterans Affairs HealthCareSystem and Arizona Health Sciences Center, Tucson, told conference attendees.
The retroprospective study examined 408 patients at Dr. Kuczynski's institution who were diagnosed with Barrett's esophagus between 1985 and 2005. Patients were followed up until the development of dysplasia, adenocarcinoma, or death. They were predominantly male (94.4%) and white (91.2%) and had a mean age of 61 years at the time of Barrett's esophagus diagnosis.
During the 6.6-year mean follow-up period, 125 patients developed dysplasia (20 high grade) and 29 developed adenocarcinoma. Approximately 66.4% of patients were prescribed a PPI for a mean duration of 31.5 months, 38.4% were prescribed a nonsteroidal anti-inflammatory drug (NSAID) for a mean duration of 12.9 months, and 26.2% were prescribed a statin for a mean duration of 10.5 months.
Only patients with Barrett's esophagus segment more than 3 cm and a more recent diagnosis of Barrett's esophagus were associated with an increased risk of dysplasia or cancer.
PPIs were associated with a 36% reduction in risk of developing dysplasia, Dr. Kuczynski told conference attendees, while not providing a P value for that finding. Differences in risk reduction for patients prescribed NSAIDs or statins were not statistically significant, he added.
According to a multivariable analysis for predicting the risk for dysplasia, the hazard ratio was 0.64 for patients with PPI prescription (95% confidence interval [CI], 0.43 - 0.94) compared with 1.53 (95% CI, 1.01 - 2.29) for those with Barrett's esophagus segments more than 3 cm.
Dr. Kuczynski cautioned that a prospective study examining PPI dose is required.
Ronnie Fass, MD, professor of medicine and director of the gastrointestinal motility laboratories at the University of Arizona in Tucson, who moderated the session, said the study confirms previous preliminary data indicating that PPIs, if taken long term, have an effect on neoplasia progression.
"In addition to their effect on patient symptoms and healing inflammation in the esophagus, there is also evidence that if you take [PPIs] on a regular basis, it may impede or halt neoplasia progression," he said. "That's an extremely important clinical message."
Dr. Fass added that the study indicates that patients diagnosed with Barrett's esophagus who are asymptomatic should be prescribed a PPI "just because of the potential of it halting their neoplasia progression."
Drs. Kuczynski and Fass have disclosed no relevant financial relationships.
Drs. Sampliner and El-Serag, 2 of the study investigators, have disclosed receiving TAP grant support. Dr. Sampliner has disclosed being on the AstraZeneca speakers bureau.
American College of Gastroenterology 2007 Annual Scientific Meeting and Postgraduate Course: Abstract 63. Presented October 17, 2007.