Gupta, S.; Fernandez, C.; Arnaout, A.; Theodossi, A.; Mendall, M.A.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA43
Academic Journal
Introduction: Controversy exists about the utility of a screening endoscopy programme and the value of proton pump inhibitors (PPI) in preventing the progression from metaplasia to dysplasia to cancer in Barrett's oesophagus (BO). Earlier studies to determine the risk of oesophageal adenocarcinoma in BO were conducted largely before the era of widespread usage of PPIs. We present a long term follow up study of subjects with BO, a high proportion of whom were on PPIs. Aims and Methods: The aim was to determine the efficacy of screening to detect oesophageal cancer in patients with BO in the context of high rates of PPI usage. All cases of BO diagnosed at our hospital from 1990 to 1998 were identified from a histopathology database. Case notes were retrieved and a database prepared. Patients who died during follow up had the cause of death ascertained from the Department of Public Health, Registry of Births and Deaths and Office of National Statistics. PPI usage was recorded at each follow up visit. Results: A total of 308 patients were identified of whom 35 patients did not nave intestinal metaplasia. 19 files could not be traced. Of the 273 subjects with intestinal metaplasia, 179 (65.6%) were male. Total follow up till October 31 2000 was 1145 patient years (1110 years with the untraceable files excluded). Mean age of diagnosis was 66.7±14.1 years (range 21-94 years). 136/156 (87.2%) patients on first follow up endoscopy, 74/79 (93.7%) patients on second follow up endoscopy and 28/32 (87.5%) patients on third follow up endoscopy were on PPIs. 12 (4%) oesophageal/ cardia adenocarcinomas were detected of which 9 were detectecl on first endoscopy. 3 cases were suspicious of at initial endoscopy. One of these was confirmed as adenocarcinoma 1 month and the other two 3 months later. Two of the 11 patients had high grade dysplasia. One of these was referred for treatment and is still alive while the other d ed of an unrelated cancer. 84 patients died during...


Related Articles


    The number of endoscopic oesophageal dilatations performed for benign stricture was observed to have decreased in our unit over the past decade, making it hard for trainees to gain experience. This trend was investigated, and compared to the rise in the use of proton pump inhibitors (PPIs)....

  • The Dose of Omeprazole Required to Achieve Adequate Intraesophageal Acid Suppression in Patients with Gastroesophageal Junction Specialized Intestinal Metaplasia and Barrett's Esophagus. Watson, Joshua; Moawad, Fouad; Veerappan, Ganesh; Bassett, John; Maydonovitch, Corinne; Horwhat, John; Wong, Roy // Digestive Diseases & Sciences;Aug2013, Vol. 58 Issue 8, p2253 

    Background: The mainstay of medical therapy for Barrett's esophagus is normalization of esophageal acid exposure with proton pump inhibitors (PPIs). However, the optimal dose and whether once daily or twice daily is required for acid suppression is unknown. Aim: The purpose of this study was to...

  • Squamous Islands in Barrett's Esophagus: What Lies Underneath? Sharma, Prateek; Morales, Thomas G.; Bhattacharyya, Achyut; Garewal, Harinder S.; Sampliner, Richard E. // American Journal of Gastroenterology;Mar1998, Vol. 93 Issue 3, p332 

    Objective: Squamous islands are frequently visualized at the time of upper endoscopy in patients with Barrett's esophagus, especially those on proton pump inhibitor therapy (PPI). The significance of these islands is not clearly understood. The aim of this study was to systematically biopsy...

  • Barrett's guidelines update includes screening, surveillance, management.  // Geriatrics;May2008, Vol. 63 Issue 5, p21 

    The article reports on the new guidelines for diagnosing and treating Barrett's esophagus published by the American College for Gastroenterology. According to the guidelines, patients with low-grade dysplasia need follow-up endoscopy within 6 months and those with high-grade dysplasia within...

  • The patterns of reflux can affect regression of non-dysplastic and low-grade dysplastic Barrett's esophagus after medical and surgical treatment: a prospective case-control study. Tolone, Salvatore; Limongelli, Paolo; Romano, Marco; Federico, Alessandro; Docimo, Giovanni; Ruggiero, Roberto; Brusciano, Luigi; Del Genio, Gianmattia; Docimo, Ludovico // Surgical Endoscopy;Mar2015, Vol. 29 Issue 3, p648 

    Background: To date, therapeutic guidelines and pattern of reflux for patients with no-dysplasia (ND) or low-grade dysplasia (LGD) Barrett's esophagus (BE) remain unclear. We aimed to analyze pattern of reflux and regression of ND- or LGD-BE after medical and surgical treatment. Methods: We...

  • Proton pump inhibitors reduce the incidence of dysplasia in Barrett's esophagus. Aguirre, Thomas; El-Serag, Hashem; Davis, Stephanie; Bhattacharyya, Achyut; Sampliner, Richard // American Journal of Gastroenterology;Sep2003 Supplement, Vol. 98, pS23 

    An abstract of the article "Proton Pump Inhibitors Reduce the Incidence of Dysplasia in Barrett's Esophagus," by Thomas Aguirre, Hashem El-Serag, Stephanie Davis, Achyut Bhattacharyya and Richard Sampliner is presented.

  • Dyspepsia management in the millennium: to test and treat or not? Delaney, B.C. // Gut;Jan2003, Vol. 52 Issue 1, p10 

    Examines the cost effectiveness of testing and treating uninvestigated dyspepsia with endoscopy for non-responders compared with empiric proton pump inhibitor (PPI) treatment followed by endoscopy, or with strategies of test and treat followed by empiric PPI, with endoscopy reserved for...

  • To Establish the Efficacy of PPI Therapy for Ulcer Bleeding in the United States, Do We Need More Patients or More PPIs? Leontiadis, Grigoris I.; Howden, Colin W. // American Journal of Gastroenterology;Sep2006, Vol. 101 Issue 9, p2000 

    Proton pump inhibitor (PPI) therapy is widely used in the management of patients with ulcer bleeding. However, most randomized controlled trials (RCTs) have been conducted outside of the United States. Jensen and colleagues have conducted the first United States-based RCT to compare a PPI with...

  • A Cost-Effectiveness Analysis of Prescribing Strategies in the Management of Gastroesophageal Reflux Disease. Gerson, Lauren B.; Robbins, Anthony S.; Garber, Alan; Hornberger, John; Triadafilopoulos, George // American Journal of Gastroenterology;Feb2000, Vol. 95 Issue 2, p395 

    OBJECTIVE: Patients who have uncomplicated gastroesophageal- reflux disease (GERD) typically present with heartburn and acid regurgitation. We sought to determine the cost-effectiveness of H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) as first-line empiric therapy for...


Read the Article


Sign out of this library

Other Topics