Acid suppression medications reduce risk of oesophageal adenocarcinoma in Barrett's oesophagus: a nested case‐control study in US male veterans

• Published in: Alimentary pharmacology & therapeutics Vol. 48; no. 4; pp. 469 - 477
• Main Authors: Tan, M. C., El‐Serag, H. B., Yu, X., Thrift, A. P.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-08-2018
• Subjects: Adenocarcinoma; Aspirin; Barrett's esophagus; Clinical trials; Diagnosis; Epidemiology; Esophageal cancer; Health risk assessment; Histamine; Inflammation; Mucous membrane; Omeprazole; Proton pump inhibitors; Statins
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.14895

Summary
Background
Proton pump inhibitors (PPIs) and histamine‐2 receptor antagonists (H2RAs) may reduce the risk of oesophageal adenocarcinoma (OAC) in Barrett's oesophagus; however, current epidemiologic studies are inconclusive.
Aim
To evaluate the independent effects of PPIs and H2RAs on risk of OAC in patients with Barrett's oesophagus.
Methods
We conducted a nested case‐control study of male veterans diagnosed with Barrett's oesophagus. Cases with incident OAC were matched by incidence density sampling on birth year and Barrett's diagnosis date to controls with Barrett's oesophagus who did not develop OAC. We identified prescription medication usage 1 year prior to Barrett's oesophagus diagnosis to 3 months prior to the OAC diagnosis. Odds ratios (OR) and 95% CI were estimated using conditional logistic regression.
Results
Compared with 798 controls, the 300 cases were less likely to use PPIs (90.0% vs 94.5%, P = 0.01) and H2RAs (19.7% vs 25.7%, P = 0.04). In the multivariable model including the use of statins, H2RAs, aspirin and nonsteroidal anti‐inflammatory drugs, PPI use was associated with 41% lower risk of OAC (OR 0.59, 95% CI 0.35‐0.99). While risk reduction of OAC was stronger for high‐dose PPIs (omeprazole daily dose >40 mg, adjusted OR 0.11, 95% 0.04‐0.36), we did not find a dose‐response relationship with PPI duration (P trend = 0.45). Likewise, H2RA use was independently associated with 30% lower risk of OAC (OR 0.70, 95% CI 0.50‐0.99).
Conclusion
Use of PPIs and H2RAs among patients with Barrett's oesophagus are associated with lower risk of OAC. Further clinical trials are needed to confirm this possible chemopreventive effect.