Continuous treatment of Barrett's oesophagus patients with proton pump inhibitors up to 13 years: observations on regression and cancer incidence.
BACKGROUND
There is little evidence that treatment of patients with Barrett's oesophagus with proton pump inhibitors over periods up to 6 years results in major regression of Barrett's oesophagus.


OBJECTIVE
To determine if longer periods of treatment with proton pump inhibitors lead to significant regression of Barrett's oesophagus, and to determine the incidence of oesophageal adenocarcinoma in the proton pump inhibitor-treated patients.


METHODS
We analysed prospectively-collected data on Barrett's oesophagus patients treated with proton pump inhibitors for 1-13 years.


RESULTS
188 patients with Barrett's oesophagus and intestinal metaplasia, were treated for 1-13 years with a proton pump inhibitor (966 years of treatment; mean 5.1 years). No change in length was seen during treatment but 48% of patients developed squamous islands (25% after 1-3 years; 100% at 12-13 years). Squamous islands correlated with treatment duration and male sex but not with proton pump inhibitor dose or patient age. Six patients developed dysplasia and three males developed adenocarcinoma during treatment (cancer incidence 0.31%).


CONCLUSIONS
Proton-pump inhibitor treatment over 1-13 years does not shorten the Barrett's oesophagus segment but squamous islands appear in many patients. The incidence of oesophageal adenocarcinoma was low in these proton pump inhibitor-treated patients compared with published series.
Gastroenterology Unit, City Hospital, Birmingham, UK. brian.cooper@swbh.nhs.uk
B T
BT
Cooper
W
W
Chapman
C S
CS
Neumann
J C
JC
Gearty
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000230:Adenocarcinoma / Q000139:chemically induced / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology; D004334:Drug Administration Schedule; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D004935:Esophageal Diseases / Q000139:chemically induced / Q000473:pathology; D004938:Esophageal Neoplasms / Q000139:chemically induced / Q000473:pathology; D005260:Female; D006801:Humans; D064747:Lansoprazole; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012737:Sex Factors; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole