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Barrett's oesophagus, proton pump inhibitors and gastrin: the fog is clearing

Kuipers, Ernst J

Gut February 2010, Vol.59(2), p.148 [Periódico revisado por pares]

BMJ Publishing Group Ltd and British Society of Gastroenterology

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  • Título:
    Barrett's oesophagus, proton pump inhibitors and gastrin: the fog is clearing
  • Autor: Kuipers, Ernst J
  • Assuntos: Barrett'S Oesophagus ; Proton Pump Inhibitor ; Gastrin ; Dysplasia ; Oesophageal Adenocarcinoma ; Barrett'S Carcinoma
  • É parte de: Gut February 2010, Vol.59(2), p.148
  • Descrição: The incidence of Barrett's oesophagus is rising rapidly.1 The presence of metaplastic tissue in the lower oesophagus is by itself an asymptomatic condition, but predisposes to oesophageal adenocarcinoma. Long-term cohort studies reported that the incidence of oesophageal cancer among patients with Barrett's oesophagus approximates 4 per 1000 patient years follow-up, and that ultimately 5–7% of patients with Barrett's oesophagus die of this condition.2 The majority of patients with Barrett's oesophagus suffer from chronic gastro-oesophageal reflux, and therefore often receive proton pump inhibitor (PPI) treatment. The effect of such treatment on Barrett's mucosa and the risk for progression to cancer have been much studied and debated. Reduction of oesophageal acid exposure decreases inflammation and proliferation, increases cell differentiation within the Barrett's segment, and might in theory reverse metaplasia, in particular in areas of ulceration. On the other hand, PPI therapy interferes with oesophageal exposure to secondary bile acids, and increases gastrin, which may induce proliferation, COX-2 upregulation, and perhaps expansion of metaplasia.3 Along this line it has been suggested that PPIs may promote progression of Barrett's metaplasia and progression to cancer. We thus have a body of seemingly conflicting research data, which are difficult to align and provide clinicians with a foggy image of this clinically relevant topic. Several hurdles obstruct progression of our knowledge. These include the lack of a suitable animal model, the difficulty to perform randomised controlled trials when most patients require acid suppression for symptom control, and the need for large, long-term studies when looking at relevant end points of dysplasia and cancer.
  • Editor: BMJ Publishing Group Ltd and British Society of Gastroenterology
  • Idioma: Inglês

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