title: Lack of incremental effect of histamine receptor antagonists over proton pump inhibitors on the risk of neoplastic progression in patients with Barrett's esophagus: a cohort study.
abstract: OBJECTIVE
  Long-term acid suppression reduces the risk of progression to esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE). Given recent reports about the harmful effects of using chronic proton pump inhibitors (PPI) there is renewed interest in alternative methods of acid suppression. Hence, we studied the effect of H2 receptor antagonists (H2RA) on the risk of progression to neoplasia in our BE cohort.
  
  
  METHODS
  This is a retrospective analysis of prospectively collected data of patients in our BE registry from 2002 to 2015. Patients' characteristics, endoscopic findings, such as the length of BE, hiatal hernia size and histological findings and patients' use of medications such as PPI, aspirin, H2RA, metformin and antihyperlipidemic agents were studied.
  
  
  RESULTS
  The cohort consisted of 1466 patients with a mean age of 61 ± 13 years. The patients had a predominance of male sex (76.7% [1118/1457]) and Caucasian race (96.6% [1209/1252]). After excluding prevalent high-grade dysplasia (HGD) or EAC, 1025 patients had a median follow up of 43.6 months during which 57 patients progressed to HGD or EAC. PPI use (56% in progressors vs 69% in non-progressors; P = 0.007) but not H2RA use (12% progressors vs 19% in non-progressors P = 0.162) was associated with lower risk of neoplastic progression. On multivariate analysis, there was no synergistic effect of addition of H2RA to PPI on risk of neoplastic progression to HGD or EAC (relative risk 0.33; confidence intervals 0.05-2.29, P = 0.262).
  
  
  CONCLUSIONS
  H2RA do not seem to have a chemopreventive role in patients with BE.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Prashanthi N
authors.initials: PN
authors.lastname: Thota
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Hajifathalian
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Tanmayee
authors.initials: T
authors.lastname: Benjamin
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Runkana
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology*; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods
chemical_list: D016588:Anticarcinogenic Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: 
  Barrett's esophagus; antagonist; dysplasia; histamine receptor; neoplasia; progression