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Answers to counter arguments to the points in the page How PPIs cause adenocarcinoma

before reading this page, please read How PPIs cause adenocarcinoma.

Oesophageal adenocarcinoma started to rise in the 1950s, before PPIs were discovered.
For instance, see the paper Analysis of Connecticut Tumor Registry data, 1940-2007. I dare say that an analysis at any early date would find this. Proton pump inhibitors are certainly not the only cause of OAC. Such data is certainly adequate to cloud the issue, but it is not evidence that PPIs are not a major cause of the current almost epidemic of OAC.
Bile is necessary for Barrett's to form and people are diagnosed with Barrett's who have not been on PPIs.
It may well be true that attempts in the lab to make oesophageal cells metaplase into Barrett's have not (yet) been successfuk without the addition of bile to the gastric juice used in the experiment. But in science, to prove a negative - that Barrett's cannot form unless bile is present - is extremely difficult! What these experiments do prove is that acid tainted with bile is more dangerous than untained gastric acid.

In any case, the argument is a bit self-defeating, for the changes that produce Barrett's - i.e. the switching off of genes by a process of methylation - are very similar to those that produce adenocarcinoma. Most of the genes methylated are the same for both, which is why Barrett's can lead to cancer. If bile promotes Barrett's it will certainly promote advabcement to OAC.

Furthermore, even if the original hypothesis is 100% true, a small amount of bile, or a transient amount of bile, may be adequate to trigger the change. In what way can the continued presence of bile be safer?

It is also hypothesised that bile without acid is safe. It may be - but to a patient there is no way off telling that the PPIs are supressing permanently and adequately enough acid to achieve this safety!

Anyway - if you ever tasted strong bile-tainted gastric fluid I think you would have few doubts!

The study that found PPIs cause biliary dyskinesia was done on only 19 people. This is too small a sample to be of any interest.
The 19 people were studied because the effect had already been noticed in another group, so in actual fact the study was on more than 19. And 15 out of 19 is an extremely high positive percentage. At the very least this finding needs disproving!

In medicine high sample population numbers are generally necessary because the points they are trying to find tend not to show up strongly in small populations. This effect showed extremely strongly in a small sample.

The problem is that doctors have had so much success with PPIs that they will not countenance that they are harmful in any serious way. So any research that agrees with the original finding tends to get disregarded or rubbished.

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Page first published: 15th November 2016.
Last modified: January 09 2020 17:32:50.
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