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Acid suppression and Barrett's oesophagus: what do we really know?
Although widely believed, the data supporting the premise that suppression of hydrochloric acid exposure to the oesophagus decreases the risk of oesophageal adenocarcinoma is inconsistent at best. In addition, it is known that bile acids may play a role in the formation of Barrett's oesophagus and oesophageal cancer, which would mean medicines like proton pump inhibitors (PPI) may not affect cancer formation in the oesophagus. This led Singh and colleagues to perform a systematic review with meta-analysis of studies evaluating the association between acid-suppressive medications (PPIs and histamine receptor antagonists (H2RA)) and the risk of oesophageal adenocarcinoma or high-grade dysplasia in patients with Barrett's oesophagus. They found seven observational studies that included a total of 2813 patients with Barrett's oesophagus and 317 cases of patients with high-grade dysplasia or oesophageal cancer, of which >80% were PPI users. On meta-analysis, PPI use associated with a 71% reduction in risk of cancer or high-grade dysplasia (adjusted OR, 0.29; 95% CI 0.12 to 0.79) with a trend towards a dose-response relationship …
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