Barrett's oesophagus and proton pump inhibitors: a pathological perspective
| Autor: | Shepherd Na |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
medicine.medical_specialty
Glandular metaplasia biology business.industry Esophageal disease medicine.drug_class Gastroenterology Proton-pump inhibitor Leading Article medicine.disease digestive system diseases medicine.anatomical_structure Pepsin Internal medicine Barrett's oesophagus medicine biology.protein Adenocarcinoma Esophagus business Pathological |
| Zdroj: | Gut. 46:147-149 |
| ISSN: | 0017-5749 |
| DOI: | 10.1136/gut.46.2.147 |
| Popis: | In Western communities, the incidence of oesophageal adenocarcinoma continues to increase in an almost epidemic manner, greater than any other common epithelial malignancy.1 2There is therefore increasing interest in the treatment strategies that reduce reflux, especially of acid, into the oesophagus in an attempt to reduce the neoplastic potential of Barrett's oesophagus/columnar lined oesophagus (CLO), the most important predisposing factor for oesophageal adenocarcinoma. The effect of surgical antireflux procedures on CLO is still controversial with no clear evidence of regression of CLO after these procedures. There is also no evidence that acid lowering drugs such as the H2 blockers can reverse the glandular metaplasia of CLO. The efficacy of the powerful acid reducing agents, the proton pump inhibitors (PPIs), in causing regression of CLO is also controversial. Although many believe that these drugs have no great effect on CLO and most accept that these drugs do not result in complete regression of CLO, in a recent issue of Gut , Peters and colleagues3have shown that high dose PPI therapy does result in partial endoscopic regression of CLO. Perhaps because of the lack of measurable success in treating CLO with acid reflux lowering procedures, there has been a veritable explosion of interest in ablative techniques, including laser, photodynamic therapy and argon beam therapy, in an attempt to reverse the glandular phenotype. This article explores the pathophysiological mechanisms behind these treatment strategies and reviews the pathological changes that result. It is generally accepted that reflux of gastric contents, particularly acid and pepsin, is the most important factor in the development of CLO in the oesophagus. Notwithstanding the widely held view that partial regression of CLO, however induced, is an inadequate end point, especially as far as cancer risk is concerned,4intuitively one would have thought that … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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