Endoscopic regression of Barrett's oesophagus during omeprazole treatment; a randomised double blind study

Peters, Frans; Ganesh, Shanthi; Kuipers, Ernst J.; Sluiter, Willem; Klinkenberg‐Knol, E. C.; Lamers, C. B. H. W.; Kleibeuker, Jan H.

doi:10.1136/gut.45.4.489

Cited by 251 publications

(153 citation statements)

References 17 publications

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“…9 Recent studies suggested a small but measurable decrease in the length of BE in patients treated with high-dose proton-pump inhibitor therapy. [10][11][12][13] However, no study has examined the effect of antisecretory therapy prior to the diagnosis of BE on the length of Barrett's segments in gastro-oesophageal reflux disease (GERD) patients with newly diagnosed BE. At the Southern Arizona Department of the Veterans Affairs (VA) Healthcare System, a single experienced endoscopist has been responsible for performing endoscopy and collecting information on prior therapy on newly referred patients with diagnosed or suspected BE over the past 20 years.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The length of newly diagnosed Barrett's oesophagus and prior use of acid suppressive therapy

El–Serag

Aguirre

Kuebeler

et al. 2004

Aliment Pharmacol Ther

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Summary Background : The length of Barrett's oesophagus seems to correlate well with indicators of severe gastro‐oesophageal reflux disease. However, it remains unknown whether prior acid suppressive therapy affects the length of newly diagnosed Barrett's oesophagus. Methods : A retrospective analysis of a well‐characterized large cohort of patients with Barrett's oesophagus diagnosed between 1981 and 2000. Aim : To compare the length of Barrett's oesophagus between patients who received acid suppressive therapy prior to their diagnosis to those who did not receive such therapy. Pharmacy records were obtained from Department of the Veterans Affairs computerized records and prospectively collected research records. We further examined the association between prior use of acid suppressive therapy and the length of Barrett's oesophagus in correlation analyses, as well as multivariate linear regression analyses while adjusting for differences in year of diagnosis, age, gender, ethnicity, and the presence of intestinal metaplasia of the gastric cardia. Results : There were 340 patients with Barrett's oesophagus first diagnosed between 1981 and 2000. The average length of Barrett's oesophagus at the time of first diagnosis was 4.4 cm (range: 0.5–16). Of all patients, 139 (41%) had prior use of histamine‐2 receptor antagonists, or proton‐pump inhibitors (41 used both), and 201 (59%) used neither prior to the diagnosis of Barrett's oesophagus. The mean length of Barrett's oesophagus was significantly shorter in patients with prior use of proton‐pump inhibitors (3.4 cm) or proton‐pump inhibitors and histamine‐2 receptor antagonists (3.1 cm) when compared to those with none of these medications (4.8 cm). In the multivariate linear regression model, the prior use of proton‐pump inhibitors or either proton‐pump inhibitors or histamine‐2 receptor antagonists was an independent predictor of shorter length of Barrett's oesophagus (P = 0.0396). Conclusions : The use of acid suppressive therapy among patients is associated with a reduction in the eventual length of newly diagnosed Barrett's oesophagus with gastro‐oesophageal reflux disease. This finding is independent of the year of diagnosis or demographic features of patients. Further studies are required to confirm this finding.

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Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16]. Of all patients, 139 (41%) had prior use of histamine-2 receptor antagonists, or proton-pump inhibitors (41 used both), and 201 (59%) used neither prior to the diagnosis of Barrett's oesophagus.…”

mentioning

confidence: 99%

The length of newly diagnosed Barrett's oesophagus and prior use of acid suppressive therapy

El–Serag

Aguirre

Kuebeler

et al. 2004

Aliment Pharmacol Ther

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“…There is published evidence that Barrett's esophagus can regress, even completely, under PPI use. However the complete circular distal squamous reepithelization of long segments of Barrett's esophagus has not been described in any of the published trials on the subject (19,20).…”

Section: First Recognized In the 19mentioning

confidence: 99%

Long segments of columnar-lined lower esophagus are not always metaplastic

Pereira¹,

Correia²,

Amaro³

et al. 2015

Rev Esp Enferm Dig

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The presence of columnar epithelium in the esophagus is associated with two conditions: Barrett's esophagus and heterotopic gastric mucosa. The former results from the metaplastic replacement of the normal distal squamous esophageal lining, is associated with gastroesophageal reflux and is a pre-neoplastic condition. The second is thought as a congenital condition, resulting from the incomplete squamous epithelialization of the esophagus during embryologic development. It is found mainly in the cervical esophagus. Histologically, Barrett's esophagus is composed of an admixture of cardiac mucosa, oxintocardiac mucosa and intestinal metaplasia. Most of heterotopic gastric mucosa consists of oxyntic mucosa where the mucosal glands are straight and composed of parietal and chief cells.There are few reports of heterotopic gastric mucosa in the lower esophagus, generally presenting as small islands.In the present report, a series of four cases of large lower esophageal heterotopic gastric mucosa is described. All patients were initially misdiagnosed with Barrett's esophagus and referred for surveillance. The correct diagnosis was based in endoscopic and histological features. In all, a circular tiny strip of squamous mucosa was observed at endoscopy between the lower end of the columnarlined esophagus and the esophagogastric junction, defined as the proximal end of the gastric folds. Biopsy samples taken from the columnar-lined segments of the four patients showed pure oxyntic mucosa.When columnar-lined esophagus is observed in the distal esophagus not in continuity with gastric mucosa, the diagnosis of heterotopic gastric mucosa must be thought and confirmed histologically by the presence of pure oxyntic mucosa.

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“…These results thus indicate that anti-reflux surgery in patients with BE does not prevent the development of EAC appreciably more than medical therapy. There is some evidence to suggest that PPIs can lead to a partial regression of BE [121,122] and delay the progression to dysplasia or EAC [123,124]. Accordingly, the increasing use of PPIs since the late 1980s might have contributed to the slight drop in the incidence of EAC over the past several decades.…”

Section: Neoplastic Preventionmentioning

confidence: 99%

“…Accordingly, the increasing use of PPIs since the late 1980s might have contributed to the slight drop in the incidence of EAC over the past several decades. Moreover, since the 1990s, several studies using varying doses of PPIs reported partial regression or the development of squamous islands [121,[125][126][127][128], while circumferential regression of the columnarized segment was rare.…”

Section: Neoplastic Preventionmentioning

confidence: 99%

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

Watari

Oshima

Fukui

et al. 2013

Clin J Gastroenterol

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Barrett's esophagus (BE) is a premalignant condition of esophageal adenocarcinoma (EAC). Although the incidence of BE has risen rapidly in the West, it is rare in Asia despite a recent increase in the prevalence of gastroesophageal reflux disease. Controversies over the definition of BE are presented because most cases show shortsegment BE, especially ultra-short BE, in Asia. Here we review possible risk factors for the development of EAC, particularly possible roles of ethnicity, specialized intestinal metaplasia (SIM), BE length, and environmental factors, such as Helicobacter pylori infection and obesity. Additionally, we summarize recent studies on the effect of chemoprevention including proton pump inhibitors, nonsteroidal anti-inflammatory drugs or aspirin in order to reduce the risk of neoplastic progression in BE patients. Although substantial knowledge of risk factors of dysplasia/EAC in BE is shown, the risk for neoplastic development may be influenced by geographic variation, study population, the presence or absence of SIM or dysplasia at baseline, and the small number of BE patients investigated. Recently, the efficiency of surveillance for BE patients has been discussed from the standpoint of cost-effectiveness. It may be too difficult to draw conclusions because no randomized clinical trials of BE surveillance have been performed.

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Endoscopic regression of Barrett's oesophagus during omeprazole treatment; a randomised double blind study

Cited by 251 publications

References 17 publications

The length of newly diagnosed Barrett's oesophagus and prior use of acid suppressive therapy

The length of newly diagnosed Barrett's oesophagus and prior use of acid suppressive therapy

Long segments of columnar-lined lower esophagus are not always metaplastic

Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

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