Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett's esophagus
Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett's esophagus
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DOI：
10.1111/j.1572-0241.2004.30228.x
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发表时间：
2004-10-01
影响因子：
9.8
通讯作者：
Sampliner, RE
中科院分区：
文献类型：
--
作者：
El-Serag, HB;Aguirre, TV;Sampliner, RE
背景食管酸暴露在Barrett食管（BE）的发病机制中很重要，目的：并可能在BE向异型增生和癌的进展中起作用。本研究的目的是比较发育不良的BE患者治疗或不治疗质子泵抑制剂（PPI）或组胺2受体拮抗剂（H2 RA）的发展方法：我们分析了前瞻性收集的数据，由一个单一的内窥镜与BE患者在VA（退伍军人事务部）设置超过20年的时间段（1981-2000年）。病理学家使用标准标准诊断BE/发育不良。1994年之后的药房信息是从计算机化数据库中检索的，并且从研究文件中检索到的。在有和没有异型增生的患者之间比较H2 RA和/或PPI使用的接受和持续时间。在Kaplan-Meier生存分析分层PPI治疗状态的发育不良的发病率进行了检查，发育不良的风险进行了检查，在考克斯多元回归分析控制人口统计学特征，BE的长度，和一年的BE diagnosis.RESULTS：我们分析了236个独特的退伍军人患者的数据，平均年龄在BE诊断为61.5岁，86%的白人，98%的男性。在1，170例患者-年的随访中，56例患者发生异型增生，年发病率为4.7%。其中14例为高度发育不良。在BE诊断后接受PPI治疗的患者中，异型增生的累积发生率显著低于未接受治疗或H2 RA的患者;对数秩检验（p < 0.001）。此外，在接受PPI治疗的患者中，使用时间较长与异型增生发生率较低相关。在多变量分析中，BE诊断后使用PPI与异型增生风险降低独立相关，风险比：0. 25（95% CI 0. 13 - 0. 47），p <0. 0001。BE的较长节段和高加索人种是发育不良的其他独立危险因素。在一般情况下，观察到类似的结果时，只有高度异型增生的情况下进行了analysed.CONCLUSIONS：这些结果表明，PPI治疗与显着降低BE患者发育不良的风险。然而，需要更多的研究来证实这一发现。
BACKGROUND Esophageal acid exposure is important in the pathogenesis of Barrett's esophagus (BE), AND AIMS: and possibly in the progression of BE to dysplasia and carcinoma. The aim of this study is to compare the development of dysplasia in BE patients treated with or without proton pump inhibitor (PPI) or histamine 2-receptor antagonist (H2RA).METHODS: We analyzed prospectively collected data by a single endoscopist on patients with BE in a VA (Veterans Affairs) setting over a 20-yr time period (1981-2000). A pathologist used standard criteria to diagnose BE/dysplasia. Pharmacy information after 1994 was retrieved from a computerized database, and from research files for the period before that. The receipt and the duration of H2RA and/or PPI use was compared between those with and without dysplasia. The incidence of dysplasia was examined in a Kaplan-Meier survival analysis stratified by PPI treatment status, and the risk of dysplasia was examined in a Cox multiple regression analysis controlling for demographic features, length of BE, and the year of BE diagnosis.RESULTS: We analyzed data for 236 unique veteran patients with a mean age at BE diagnosis of 61.5 yr, 86% Caucasian, and 98% male. During 1,170 patient-yr of follow-up, 56 patients developed dysplasia giving an annual incidence rate of 4.7%. Of those, 14 had high-grade dysplasia. The cumulative incidence of dysplasia was significantly lower among patients who received PPI after BE diagnosis than in those who received no therapy or H2RA; log rank test (p < 0.001). Furthermore, among those on PPIs, a longer duration of use was associated with less frequent occurrence of dysplasia. In multivariate analysis, the use of PPI after BE diagnosis was independently associated with reduced risk of dysplasia, hazards ratio: 0.25 (95% CI 0.13-0.47), p < 0.0001. Longer segments of BE and Caucasian race were other independent risk factors for developing dysplasia. In general, similar findings were observed when only cases with high-grade dysplasia were analyzed.CONCLUSIONS: These results indicate that PPI therapy is associated with a significant reduction in the risk of developing dysplasia in patients with BE. However, more studies are required to confirm this finding.