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