Purpose: In the past 100 years we have witnessed an increase in the prevalence of Barrett's Esophagus (BE) and adenocarcinoma of the esophagus. Traditional practice has been to treat BE with proton pump inhibitors (PPIs) with the presumption that suppressing acid will prevent dysplasia and subsequent cancer. Our institution began a registry nearly 20 years ago to learn if patients with Barrett's esophagus developed dysplasia while receiving PPIs.
Methods: Charts of 435 patients followed at our institution since 1992 were reviewed. Data was collected with regard to gender, PPI dosage, years in follow-up, age at diagnosis and histology. Inclusion criteria were patients diagnosed with BE between the ages of 18 and 75 at index endoscopy and on daily PPIs. Exclusionary criteria included interruption in therapy, high grade dysplasia and failure to comply with surveillance protocol. The primary objective was to determine if dysplasia developed in patients on PPIs. Secondary objectives were to see if daily vs. BID PPI dosing made an difference in progression and if low grade dysplasia (LGD) would progress to high grade dysplasia (HGD).
Results: 238 patients met screening criteria (M=148; F=90). The mean follow-up time was 6.8 years with a median time of 9 years. The average age of males was 59.7 years and females 54.5 years. 220 patients had simple BE and 18 had LGD. No LGD patients progressed to HGD and only 3 simple BE patients developed LGD. 143 patients were treated with once daily therapy and 95 on BID therapy. All 3 patients that progressed were on BID therapy.
Conclusion: 1. Progression of BE to LGD in patients receiving PPIs was low at 1.2%. 2. No gender differences were observed. 3. Though no LGD patients progressed to HGD too few patients were followed to make a statistical conclusion. 8 of the 18 patients did have follow-up times of over 10 years. 4. There was no statistical difference between daily and BID therapy but the important questions are whether those patients on daily therapy had complete acid suppression or is complete acid suppression necessary to prevent dysplasia?