PPI Use may Not Prevent High-grade Dysplasia and Oesophageal Adenocarcinoma in Barrett’s Oesophagus: A Nationwide Study of 9883 clinical Patients

Hvid-Jensen F, Pedersen L, Funch-Jensen P, Drewes A. Aliment Pharmacol Ther. 2014 May;39(9):984-91.

OBJECTIVES: To investigate if the intensity and adherence of PPI use among all patients with BO in Denmark affected the risk of oesophageal adenocarcinoma.

RESULTS: We identified 140 cases with incident oesophageal adenocarcinomas and/or high-grade dysplasia, with a median follow-up time of 10.2 years. The relative risk of oesophageal adenocarcinoma or high-grade dysplasia was 2.2 (0.7-6.7) and 3.4 (95% CI: 1.1-10.5) in long-term low- and high-adherence PPI users respectively.

CONCLUSION: No cancer-protective effects from PPI’s were seen. In fact, high-adherence and long-term use of PPI were associated with a significantly increased risk of adenocarcinoma or high-grade dysplasia. This could partly be due to confounding by indication or a true negative effect from PPIs. Until the results from future studies hopefully can elucidate the association further, continuous PPI therapy should be directed at symptom control and additional modalities considered as aid or replacement.