Proton pump inhibitors may reduce the risk of high-grade dysplasia and/or esophageal adenocarcinoma in Barrett’s esophagus: a systematic review and meta-analysis

ABSTRACT

Background

Barrett’s esophagus (BE) is an important risk factor for high-grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC). The effect of proton pump inhibitors (PPIs) on the chemoprevention of HGD and/or EAC arising from BE remains controversial.

Research Design and Methods

PubMed, EMBASE, and Cochrane Library databases were systematically searched. Risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by a random-effect model. Heterogeneity and its potential source were assessed.

Results

Fifteen studies with 26,291 BE patients were included. Meta-analysis of eight cohort studies showed that PPIs can significantly reduce the risk of HGD and/or EAC in BE patients (RR = 0.46; P < 0.001), but meta-analysis of six case-control studies showed no significant benefit of PPIs (OR = 0.64; P = 0.334). Heterogeneity was significant among both cohort and case-control studies, which might be attributed to the information sources of PPIs. There was no significant protective effect of high-dose PPIs on HGD and/or EAC in one RCT (RR = 0.84; P = 0.21), meta-analysis of two cohort studies (RR = 0.61; P = 0.28), or meta-analysis of two case-control studies (OR = 0.32; P = 0.08).

Conclusions

Chemoprevention of HGD and/or EAC by PPIs may be considered in BE patients. However, there might not be further preventive effect of high-dose PPIs.

KEYWORDS:

• Barrett’s esophagus
• esophageal adenocarcinoma
• high-grade dysplasia
• proton pump inhibitors
• incidence

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

X Qi contributed to conceptualization; H Yao and X Qi contributed to the methodology; H Yao and X Qi contributed to the formal analysis; H Yao, L Wang, H Li, S Xu, Z Bai, H Chen and X Qi contributed to data curation; H Yao, L Wang and X Qi contributed to writing the original draft; L Wang, H Li, S Xu, Z Bai, Y Wu, H Chen, H Goyal and X Qi contributed to writing and editing the review; X Qi contributed to supervision.

Supplementary material

Supplemental data for this article can be accessed here.