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Current Gastroenterology Reports

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09-11-2023 | Proton Pump Inhibitors

Revisiting Proton Pump Inhibitors as Chemoprophylaxis Against the Progression of Barrett’s Esophagus

Authors: Shawn L. Shah, Kerry Dunbar

Published in: Current Gastroenterology Reports | Issue 12/2023

Abstract

Purpose of Review

Barrett’s esophagus (BE) is associated with chronic gastroesophageal reflux disease and is a known precursor to esophageal adenocarcinoma. While endoscopic surveillance strategies and the role for endoscopic eradication therapy have been well established, there has been much interest in identifying chemopreventive agents to disrupt or halt the metaplasia-dysplasia-carcinoma sequence in patients with BE.

Recent Findings

No pharmacological agent has held more hope in reducing the risk of neoplastic progression in BE than proton pump inhibitors (PPIs). However, data supporting PPIs for chemoprevention have largely been from observational cohort and case–control studies with mixed results.

Summary

In this review, we revisit the literature and highlight the role of PPIs in patients with BE as it pertains to chemoprophylaxis against the progression of BE to dysplasia and esophageal adenocarcinoma.

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17.

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18.

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19.

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20.

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21.

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22.

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23.

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24.

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25.

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26.

El-Serag HB, Aguirre TV, Davis S, et al. Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett’s esophagus. Am J Gastroenterol. 2004;99(10):1877–83. https://doi.org/10.1111/j.1572-0241.2004.30228.x.CrossRefPubMed

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28.••

Jankowski JAZ, de Caestecker J, Love SB, et al. Esomeprazole and aspirin in Barrett’s o oesophagus (AspECT): a randomised factorial trial. Lancet. 2018;392(10145):400–8. https://doi.org/10.1016/S0140-6736(18)31388-6. The Aspirin and Esomeprazole Chemoprevention in Barrett’s metaplasia Trial (AspECT) is the only randomized study to date to evaluate the chemopreventive impact of proton pump inhibitors (PPIs). The study findings suggest that high-dose PPI confers benefits in reducing the progression of BE.CrossRefPubMedPubMedCentral

29.

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30.

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35.

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38.••

Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin. Gastroenterology. 2019;157(3):682-691.e2. https://doi.org/10.1053/j.gastro.2019.05.056. This is the largest randomized controlled study to date assessing and highlighting the safety of proton pump inhibitors in a 3-year trial among 17,598 patients.CrossRefPubMed

39.

Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2022;117(1):27–56. https://doi.org/10.14309/ajg.0000000000001538.CrossRefPubMedPubMedCentral

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41.••

Targownik LE, Fisher DA, Saini SD. AGA clinical practice update on de-prescribing of proton pump inhibitors: expert review. Gastroenterology. 2022;162(4):1334–42. https://doi.org/10.1053/j.gastro.2021.12.247. This is the American Gastroenterological Association (AGA) clinical practice update on de-prescribing of proton pump inhibitors. The experts recommend that patients with Barrett’s esophagus generally should not undergo a trial of de-prescribing.CrossRefPubMed

42.

Muthusamy VR, Wani S, Gyawali CP, et al. AGA clinical practice update on new technology and innovation for surveillance and screening in Barrett’s esophagus: expert review. Clin Gastroenterol Hepatol. 2022;20(12):2696-2706.e1. https://doi.org/10.1016/j.cgh.2022.06.003.CrossRefPubMedPubMedCentral

43.••

Shaheen NJ, Falk GW, Iyer PG, et al. Guideline to practice: diagnosis and management of Barrett’s esophagus: an updated ACG guideline. Am J Gastroenterol. 2022;117(8):1177–80. https://doi.org/10.14309/ajg.0000000000001788. This is the updated American College of Gastroenterology (ACG) guidelines on the diagnosis and management of Barrett’s esophagus (BE). The authors do not make recommendations regarding chemoprevention due to insufficient data; however, they do recommend at least daily PPI use in patients with BE.CrossRefPubMedPubMedCentral

44.

Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63(1):7–42. https://doi.org/10.1136/gutjnl-2013-305372.CrossRefPubMed

Title: Revisiting Proton Pump Inhibitors as Chemoprophylaxis Against the Progression of Barrett’s Esophagus
Authors: Shawn L. Shah
Kerry Dunbar
Publication date: 09-11-2023
Publisher: Springer US
Keywords: Proton Pump Inhibitors
Gastroesophageal Reflux Disease
Barrett Esophagus
Published in: Current Gastroenterology Reports / Issue 12/2023
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI: https://doi.org/10.1007/s11894-023-00905-5

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