Acid suppression therapy may not alter malignant progression in Barrett's metaplasia showing p53 protein accumulation

Proton Pump Inhibitors Are Associated with Reduced Incidence of Dysplasia in Barrett's Esophagus

“…Carlson et al found that once p53 overexpression occurred in metaplastic cells, progression to dysplasia was more likely to occur despite acid suppressive therapy (31). This suggests that once genetic instability has occurred progression is likely despite suppressing reflux.…”

Lack of incremental effect of histamine receptor antagonists over proton pump inhibitors on the risk of neoplastic progression in patients with Barrett's esophagus: a cohort study

“…The evidence for this concept is, however, less robust, with several studies showing a lack of effect of acid suppression on progression to EAC. 5,6 However, a recent meta-analysis 7 showed PPI use was associated with a reduction in the risk of high-grade dysplasia (HGD) or EAC of 71% in patients with BE. In addition, a longer duration of PPI use was associated with greater protection.…”

Die Belegzelle des Magens: diametrale Bedeutung für die gastroösophageale Refluxkrankheit (GERD)

“…Repeated exposure to regurgitated acidic gastric juice is well known to defeat the first line of squamous epithelial defense mechanisms [65] and, in the long run, lead to metaplasia. However, acid is not the full story as many patients with GERD who have controlled gastric and esophageal pH with proton pump regulators still progress to Barrett's and EADC [8,28]. The presence of pepsin, bile, and trypsin in refluxed gastric juice are proposed an additional, or alternative, disruptive factors for the development of IM in the esophagus [41,42,61,67], and more recent tests of this hypothesis have been carried out in patients [56] and in vitro [61].…”