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Do proton pump inhibitors prevent Barrett’s esophagus progression to high-grade dysplasia and esophageal adenocarcinoma? An updated meta-analysis

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 04 June 2021

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.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

EAC:

Esophageal adenocarcinoma

EC:

Esophageal cancer

GE:

Gastroesophageal

GERD:

Gastroesophageal reflux disease

HGD:

High-grade dysplasia

HR:

Hazard ratio

LGD:

Low-grade dysplasia

LSBE:

Long-segment Barrett’s esophagus

NA:

Not applicable

NDBE:

Non-dysplastic Barrett’s esophagus;

NOS:

Newcastle–Ottawa Scale

NR:

Not reported

NSAIDs:

Nonsteroidal anti-inflammatory drugs

OR:

Odd ratio

PPI:

Proton pump inhibitor

PRISMA:

Preferred reporting project declared by the systematic review and meta-analysis

PROSPERO:

Prospective register of systematic reviews

RR:

Relative risk

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Funding

No sources of funding were used to conduct this study.

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Authors and Affiliations

  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

    Yue Chen & Lei Hu

  2. Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA

    Chenyu Sun

  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

    Yile Wu & Xin Chen

  4. Department of Gastroenterology, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA

    Sujatha Kailas & Zeid Karadsheh

  5. Community Healthcare System, 901 MacArthur Blvd, Munster, IN, 46321, USA

    Guangyuan Li

  6. Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA, 02115, USA

    Zhichun Guo & Hongru Yang

  7. Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Qin Zhou

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  1. Yue Chen
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Contributions

YC performed literature search, collected the data, statistical analysis and wrote the manuscript. CS designed the study, performed literature search, collected the data, performed statistical analysis and wrote the manuscript. YW performed statistical analysis, revised the manuscript and provided critical opinion. XC analyzed and interpreted the data. SK, ZK, and GL provided critical opinion and revised the manuscript. ZG and HY revised the manuscript LH participated in the literature search. QZ provided critical opinion, participated in literature search, and revised the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Chenyu Sun.

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Chen, Y., Sun, C., Wu, Y. et al. Do proton pump inhibitors prevent Barrett’s esophagus progression to high-grade dysplasia and esophageal adenocarcinoma? An updated meta-analysis. J Cancer Res Clin Oncol 147, 2681–2691 (2021). https://doi.org/10.1007/s00432-021-03544-3

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