Acid suppression cuts cancer risk in Barrett’s esophagus

In patients with Barrett’s esophagus ( BE), acid suppression with proton pump inhibitors ( PPIs) and histamine - receptor antagonists ( H RA) reduced the risk of progression to esophageal adenocarcinoma (EAC), according to findings presented at the annual Digestive Disease Week.

In the nested, case- control study, PPIs reduced the risk of EAC by 69 percent and H RAs reduced the risk by 45 percent.

“The guidelines for these agents are based on symptoms of reflux. Although this study does not tell us for sure, it looks like taking these medications [in Barrett’s esophagus] prevents cancer,” said a postdoctoral research fellow at Baylor College of Medicine, Houston.

There is a “deficiency of studies of cases with longitudinal follow-up in a cohort of BE patients examining the effects of PPIs and H RAs on progression to EAC.” “We conducted this study in a large cohort of BE patients and hypothesized that acid suppression with PPIs and H RAs would decrease the risk of EAC.”

The observational study comprised 29,536 male veterans diagnosed with BE between 2004 and 2009, in the Veterans Affairs Corporate Data Warehouse. Of those, 760 had an ICD-9 diagnosis of EAC. Cases of incident BE (in patients who developed EAC) were matched with controls with BE who did not develop cancer by the time of each EAC diagnosis in the corresponding case. Cases were followed until 2011.

The final analysis based on 311 cases with EAC after BE and 856 matched controls with no EAC. Use of acid suppression was based on reports from a Veterans Affairs pharmacy.

Patients with EAC were significantly more overweight and obese than were controls and were more often cigarette smokers. Cases were less likely (65 percent) than were controls (83 percent) to fill at least one prescription for a PPI. A total of 8 percent of cases had at least one prescription for an H RA compared with 14 percent of controls.

For PPIs, duration of use was not associated with risk; the opposite was true for H RA users.

“Can’t say with certainty that PPI and H RA use reduce the risk of cancer,”

“But the study suggests that there may be a role for these medications. Further study is needed.”

It is noted that the risk of developing EAC in people with BE is low – 0.5 percent per year.

In the question and answer session, that it is disturbing that so many BE patients are not on acid suppression. “There are no clear-cut guidelines that state that BE patients should be on PPI,” “Maybe that’s why primary care doctors are not prescribing them.”

In a talk after the presentation, UT Southwestern Medical Center, Dallas, said it appears that clonal diversity at diagnosis of BE identifies patients likely to develop EAC. “If these cells are predestined to become cancer, can they achieve salvation through good acts?” study suggests that they can. The malignant potential of BE may be predetermined, and acid suppression therapy reduces the risk of progression to EAC.”