Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett's oesophagus
Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett's oesophagus
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DOI：
10.5694/j.1326-5377.2004.tb05991.x
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发表时间：
2004-04-19
影响因子：
11.4
通讯作者：
Clarke, AC
中科院分区：
文献类型：
--
作者：
Hillman, LC;Chiragakis, L;Clarke, AC
目的：检查质子泵抑制剂 (PPI) 治疗是否影响巴雷特食管患者异型增生的发生率和进展。设计和设置：回顾 1981 年至 2001 年间在澳大利亚首都领地堪培拉私人内窥镜中心接受定期内窥镜检查和活检的患者的前瞻性数据。患者：350 名诊断为巴雷特食管的患者。干预：PPI 治疗从 1989 年底开始逐步引入临床实践。一旦开始，PPI 治疗就持续进行，没有试图减少剂量。主要结果指标：不典型增生或腺癌的发展与 Barrett 食管诊断和开始 PPI 治疗之间的延迟之间的关系通过 Cox 回归分析确定，按入组年份分层。年龄、性别、肉眼可见标志物（严重食管炎、结节、巴雷特溃疡、狭窄）以及阿司匹林或非甾体类抗炎药的使用被认为是回归分析中的混杂因素。 结果：350 名患者接受了 1422 次内窥镜检查，中位随访时间为 4.7 年。诊断为巴雷特食管后延迟使用 PPI 2 年或更长时间的患者在任何给定时间出现低度不典型增生的风险是第一年使用 PPI 的患者的 5.6 倍（95% CI，2.0-15.7）。对于发生高度不典型增生或腺癌的风险也发现了类似的结果（风险比，20.9；95% CI，2.8-158）。 结论：持续使用 PPI 治疗似乎有益于预防巴雷特食管患者的不典型增生和腺癌。我们建议所有患有这种疾病的患者，即使是没有食管炎或症状的患者，也应鼓励继续长期 PPI 治疗。
Objective: To examine whether proton-pump inhibitor (PPI) therapy influences the incidence and progression of dysplasia in patients with Barrett's oesophagus.Design and setting: Review of prospective data on patients undergoing surveillance with regular endoscopy and biopsy at a private endoscopy centre in Canberra, ACT, between 1981 and 2001.Patients: 350 patients diagnosed with Barrett's oesophagus.Interventions: PPI therapy was progressively introduced into clinical practice from late 1989. Once begun, PPI therapy was ongoing, with no attempt to reduce the dose.Main outcome measures: Relationship between development of dysplasia or adenocarcinoma and delay between diagnosis with Barrett's oesophagus and starting PPI therapy was determined by Cox regression analyses, stratified by year of enrolment. Age, sex, presence of macroscopic markers (severe oesophagitis, nodularity, Barrett's ulcer, stricture) and use of aspirin or non-steroidal anti-inflammatory drugs were considered as confounding factors in the regression analyses.Results: The 350 patients had 1422 surveillance endoscopies, with a median follow-up of 4.7 years. Patients who delayed using a PPI for 2 years or more after diagnosis with Barrett's oesophagus had 5.6 times (95% CI, 2.0-15.7) the risk of developing low-grade dysplasia at any given time as those who used a PPI in the first year. Similar results were found for the risk of developing high-grade dysplasia or adenocarcinoma (hazard ratio, 20.9; 95% CI, 2.8-158).Conclusions: Use of ongoing PPI therapy appeared beneficial in the prevention of dysplasia and adenocarcinoma in patients with Barrett's oesophagus. We suggest that all patients with this condition, even those with no oesophagitis or symptoms, should be encouraged to continue long term PPI therapy.