Document Detail


The evidence base of proton pump inhibitor chemopreventative agents in Barrett's esophagus--the good, the bad, and the flawed!
MedLine Citation:
PMID:  17266685     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Gastric acid is believed to be an important etiological factor in the pathogenesis of Barrett's esophagus. Pulsatile acid exposure increases cell proliferation in ex vivo Barrrett's tissue and normalization of esophageal pH reverses this. Proton pump inhibitors (PPIs) are the mainstay of therapy in Barrett's esophagus, and have numerous beneficial effects including symptom control, reduction of inflammation, and promotion of the development of squamous islands. However, PPI therapy causes hypergastrinemia and has not prevented recent increase in the incidences of esophageal cancer. Additionally, evidence presented here by Feagins et al. suggests that acid exposure has a p53-mediated, antiproliferative effect on a nondysplastic Barrett's epithelial cell line, an effect that acid suppression might abrogate. These complex pH, inflammation, and growth factor biological interactions can be most reliably tested in large clinical trials with hard end points like cancer conversion or all causes of mortality. Combining the anti-inflammatory effects of acid suppression with aspirin, a nonsteroidal anti-inflammatory agent, is the subject of the AspECT clinical trial, and this may be the future of chemoprevention in Barrett's.
Authors:
Simon Leedham; Janusz Jankowski
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Publication Detail:
Type:  Comment; Editorial    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  102     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-02-01     Completed Date:  2007-03-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  21-3     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Anti-Ulcer Agents / therapeutic use*
Aspirin / therapeutic use
Barrett Esophagus / etiology*,  pathology,  prevention & control*
Chemoprevention / methods
Evidence-Based Medicine
Gastroesophageal Reflux / complications,  prevention & control
Humans
Hydrogen-Ion Concentration
Precancerous Conditions
Proton Pumps / antagonists & inhibitors*
Tumor Suppressor Protein p53 / metabolism
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Anti-Ulcer Agents; 0/Proton Pumps; 0/Tumor Suppressor Protein p53; 50-78-2/Aspirin
Comments/Corrections
Comment On:
Am J Gastroenterol. 2007 Jan;102(1):10-20   [PMID:  17266684 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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