Yue Chen1, Chenyu Sun2, Yile Wu3, Xin Chen3, Sujatha Kailas4, Zeid Karadsheh4, Guangyuan Li5, Zhichun Guo6, Hongru Yang6, Lei Hu1, Qin Zhou7. 1. Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China. 2. Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA. drsunchenyu@yeah.net. 3. Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China. 4. Department of Gastroenterology, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA. 5. Community Healthcare System, 901 MacArthur Blvd, Munster, IN, 46321, USA. 6. Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA, 02115, USA. 7. Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Abstract
PURPOSE: Previous research on the association between proton pump inhibitor (PPI) use and the risk of progression to high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) in Barrett's Esophagus (BE) patients has generated inconsistent findings. This meta-analysis was performed to clarify the association. METHODS: We performed a comprehensive search strategy to select relevant studies up to September 2020. Heterogeneity was assessed using the I-squared statistic. Odds ratios (OR) and 95% confidence intervals (CI) were calculated through either fixed-effects or random-effects model. Duration-response was also performed to assess the gain effects of different PPI intake duration. Sensitivity analysis, subgroup analyses, and tests for publication bias or other small-study effects were conducted. RESULTS: Twelve studies with 155,769 subjects were included. The PPI use was associated with the reduced risk of BE progression to HGD/EAC (OR = 0.47, 95% CI = 0.32-0.71). In the duration-response analysis, the estimated OR for decreased risk of HGD/EAC with PPI intake duration of 12 months was 0.81 (95% CI = 0.71-0.91). Sensitivity analysis suggested the results of this meta-analysis were stable. No publication bias was detected. CONCLUSIONS: PPI use is associated with a decreased risk of HGD/EAC in patients with BE. For further investigation, that more well-designed studies are still needed to elucidate the protective effect of PPI usage on BE patients to prevent HGD/EAC.
PURPOSE: Previous research on the association between proton pump inhibitor (PPI) use and the risk of progression to high-grade dysplasia (HGD)/esophageal adenocarcinoma (EAC) in Barrett's Esophagus (BE) patients has generated inconsistent findings. This meta-analysis was performed to clarify the association. METHODS: We performed a comprehensive search strategy to select relevant studies up to September 2020. Heterogeneity was assessed using the I-squared statistic. Odds ratios (OR) and 95% confidence intervals (CI) were calculated through either fixed-effects or random-effects model. Duration-response was also performed to assess the gain effects of different PPI intake duration. Sensitivity analysis, subgroup analyses, and tests for publication bias or other small-study effects were conducted. RESULTS: Twelve studies with 155,769 subjects were included. The PPI use was associated with the reduced risk of BE progression to HGD/EAC (OR = 0.47, 95% CI = 0.32-0.71). In the duration-response analysis, the estimated OR for decreased risk of HGD/EAC with PPI intake duration of 12 months was 0.81 (95% CI = 0.71-0.91). Sensitivity analysis suggested the results of this meta-analysis were stable. No publication bias was detected. CONCLUSIONS: PPI use is associated with a decreased risk of HGD/EAC in patients with BE. For further investigation, that more well-designed studies are still needed to elucidate the protective effect of PPI usage on BE patients to prevent HGD/EAC.
Authors: Deepak L Bhatt; Byron L Cryer; Charles F Contant; Marc Cohen; Angel Lanas; Thomas J Schnitzer; Thomas L Shook; Pablo Lapuerta; Mark A Goldsmith; Loren Laine; Benjamin M Scirica; Sabina A Murphy; Christopher P Cannon Journal: N Engl J Med Date: 2010-10-06 Impact factor: 91.245
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