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• W2056538550 abstract "As pointed out in the letter by Dr Rosch, the effect of continuous proton pump inhibitor (PPI) therapy in patients with Barrett's oesophagus might at best be symptomatic treatment, whereas – of more concern – it could potentially promote dysplastic progression and adenocarcinoma rather than prevent it.1 We initially hypothesised that patients in our Barrett's cohort who were taking their PPI medication regularly (very high adherence) were less likely to develop dysplasia and adenocarcinoma. However, we were surprised to find that the opposite seemed to be the case.2 As already discussed in our article, this effect would by some be attributed to confounding by indication, i.e. patients need more PPI to relieve symptoms due to larger amounts of reflux. This relationship may be true for some of the patients; however, the causality is more complex. We minimised this bias by excluding PPI use within 1 year of either the dysplasia or adenocarcinoma diagnosis. Furthermore, symptoms correlate poorly with the actual amount of reflux, and the presence of Barrett's oesophagus may in fact make patients more hyposensitive to acid reflux.3-6 It is worrying that the worldwide incidence of oesophageal adenocarcinoma has taken an exponential rise despite, or as debated in the letter by Dr Rosch it may, at least, hypothetically relate to, increasing use of long-term PPI medication in the same time period. Whether prescribed as symptom control or intuitive for the clinician as prevention of dysplasia, we must conclude on the basis of our data that it is debatable whether PPI has a preventive effect on the development of oesophageal adenocarcinoma. The most important reason for this could be the deleterious effect of PPIs causing an increased alkalisation of refluxed bile acids, which are more mutagenic, on the oesophageal mucosa as shown by several recent studies.7-9 Clinicians should be aware of this potential interaction and we recommend that the potential harm of PPI treatment in patients with Barrett's oesophagus should be addressed in future studies. The authors' declarations of personal and financial interests are unchanged from those in the original article.2" @default.
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• W2056538550 date "2014-07-09" @default.
• W2056538550 modified "2023-09-23" @default.
• W2056538550 title "Letter: proton pump inhibitors, GERD and oesophageal adenocarcinoma - authors' reply" @default.
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• W2056538550 doi "https://doi.org/10.1111/apt.12847" @default.
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