Does chemoprevention of Barrett's esophagus using acid suppression and/or COX-2 inhibition prevent neoplastic progression?
Barrett's esophagus--intestinal metaplasia within the tubular esophagus - is a premalignant histologic lesion and a marker of cancer risk. Strategies to prevent Barrett's-related esophageal cancer have focused on reversal of Barrett's using pharmacological or surgical antireflux therapies and endoscopically-induced injury. Currently, however, there is little compelling evidence to support the reversal of Barrett's through pharmacological or surgical therapy, and endoscopic reversal of Barrett's has not yet been validated. Chemoprevention using intensive acid suppression and/or inhibition of cyclooxygenase-2 (COX-2) with nonsteroidal anti-inflammatory drugs remains a biologically plausible strategy that is supported by a rapidly growing body of scientific evidence. Data suggest that a combination of acid suppression with COX-2 inhibition might be the most effective chemopreventive strategy. Whether this approach is effective awaits the results of well-designed outcomes studies.
Fennerty
M Brian
MB
Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
D000230:Adenocarcinoma / Q000209:etiology / Q000517:prevention & control*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000209:etiology / Q000517:prevention & control*; D006356:Heartburn / Q000150:complications / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D011451:Prostaglandin-Endoperoxide Synthases; D016032:Randomized Controlled Trials as Topic
D000897:Anti-Ulcer Agents; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D009853:Omeprazole