For new members with concerns about Barretts

Hi Teacherman,

I understand your worry. You are in a tough position. I also seem to get some side-effects from PPI's, but luckily have not been diagnosed with Barrett's.

I asked a famous study author from Denmark a number of questions, among them:

"1) Does being on a PPI reduce cancer risk? (I have read that bile reflux on the gastric cardia causes stem cells to change to Barrett's, and then cancer, so it seems to me like PPI's might not help cancer risk)..."

His response was

"Not much scientific support, but a very recent study have indicated a modest effect."

However, specifically in terms of Barrett's esophagus, Dr. Nicholas Shaheen has an brief article titled "Data Support PPI use in Barrett's patients" from just April of this year. Here is the textt below:

Everyone taking care of Barrett's patients has heard the question. "Really? I have to take these acid pills forever? Forever is a long time!" Given the popular media barrage associated with every putative side effect of proton pump inhibitors (PPIs), it is to be expected that patients might be uneasy.

Kastelein and colleagues provide the best data yet in support of this approach. PPI use in their observational study was associated with a substantial risk reduction in cancer and high-grade dysplasia, both at study enrollment and in follow-up.

This is far-from-perfect evidence of a protective effect of PPIs in Barrett's. As the authors recognize, there are several substantial issues limiting the study's generalizability. The few patients who were not on a PPI may differ substantially from the rest in multiple unmeasurable ways. Also, to the credit of the Dutch health care system, 99% of Barrett's patients were on PPIs for at least part of the follow-up, and 97% of total follow-up time was spent on PPIs. Therefore, the investigators had few non-PPI years to assess. In fact, the entire study really hinges on 12 years of non-PPI follow-up in subjects destined to go on to high-grade dysplasia/cancer.

Despite these limitations, this prospective study is the best to date, and may be the best we see on this topic. Given the weight of the observational data supporting PPI use in Barrett's, a randomized controlled trial of PPIs versus placebo as an antineoplastic measure in Barrett's will not likely be undertaken. Given the risk-benefit ratio, we should continue to promote PPI use in our Barrett's patients, while acknowledging the less-than-perfect evidence underpinning this recommendation.

He has another one titled "Barrett esophagus: Will effective treatment prevent the risk of progression to esophageal adenocarcinoma?", that you might be interested in.

MMM-

You are correct about not using PPIs with a functioning wrap. If they have persistent issues some have to stay on a usually lower dose.
I was taken of PPIs the day of my surgery. I just have to have an EGD every 3 years now to check that it hasn't spread or changed any. With a functioning wrap it shouldn't advance any.

Take care,
Bill

http://www.gastrojournal.org/article/S0016-5085(13)00496-4/abstract?referrer=http%3A%2F%2Fscholar.google.co.uk%2Fscholar%3Fstart%3D10

This study confirms others that we have looked at and is very recent (April 2013) - overall risk for people with Barretts is 2% (risk of death from cancer of oesophagus) but the biggest cause of death is heart disease. The article suggests interventions be considered to reduce this risk. They don't speculate why there is increased risk of heart disease amongst people with Barretts though, nor do they suggest a common cause.

MMM


"CONCLUSION: Among patients with BE, approximately 2% will die of esophageal cancer within 10 years. However, patients with BE died more frequently of other causes, such as ischemic heart disease. Evidence-based strategies are available to prevent this disease and might be more cost-effective for reducing mortality among patients with BE."

Post Edited (mudmagnetmum) : 7/2/2013 10:26:12 AM (GMT-6)

That wasn't in that particular study but I think is mentioned in some of the earlier links near the beginning of this thread. One of the links goes to a document with a useful pie chart showing deaths from all causes.

If I get more time I'll try to find a more specific answer for you!

MMM

hi mudmag. thanks for bumping this. i was in a rush for work when i posted and didn't look for it. i will read the whole thread. :)

I get the gist, but don't fully understand this report. I guess it's saying 'keep taking the tablets' [or capsules].

 

Rhode Island Hospital Uncovers Pathway Linking Heartburn and Esophageal Cancer

 

http://www.lifespan.org/Newsroom/News.aspx?NewsId=63293/Rhode-Island-Hospital-Uncovers-Pathway-Linking-Heartburn-and-Esophageal-Cancer/

Bumped for new members

Just more proof the doctors can't agree, therefore don't really know anything for sure.......same as one day eggs etc.. are good for you and the next day or doctor say's eggs etc... will kill you. Bottom line....they just don't know!

I had a quick look at Rhode Island and ppi info - they are saying to double intake to twice daily to prevent cancer on the article I read. Hmmm. . . . Have everyone on double dose, now who benefits the most from that?!

MMM

MMM, the group at RefluxMD feels that PPI'S only relieve symptoms, that it is not the acid that causes the damage to the esophagus. They believe that ppi use accounts for the increase in esophageal cancernin recent years, though it is still rare. But they are surgeons and also benefit from this advice. I agree with your indirect suggestion that perhaps a pharmaceutical company funded the Rhode Island study. I also am not pursuing surveillance.

Hi Sunbeam,

Do you know if there are any studies showing that PPIs increase the cancer risk? How can they separate PPI use from other factors, as most people with symptoms are going to take a PPI. Whatever causes the symptoms also causes the need to take medication, so unless there is a massive group of people who have taken no PPI but who have had reflux (acting as a control group), I don't get how they can prove any of this.

What is striking is that the clinical approach and attitude both to Barretts and to reflux is not the same from one country to another!

I'm starting up a new thread with just the original links for this topic, as the main take home point, that when you look at deaths from ALL causes then Barretts should be the least of our worries, is buried somewhere on page 1 !

MMM