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Is Barrett's Oesophagus really a pre-cancerous condition?
I believe that is is a mistake to label Barrett's oesophagus to be a pre-cancerous condition. By any measure, life itself is a pre-cancerous condition - for some people, but not for others. Surely Barrett's is only pre-cancerous condition for a very few unfortunate people! The reasons it is said to be pre-cancerous are historical and do not measure up to modern knowledge. Let us consider a few facts.
Barrett's oesophagus was first identified by Norman Barrett in 1950. In those days there were no endoscopies - the modern equipment did not exist. He surely identified the condition from autopsies - on people who had died from oesophageal adenocarcinoma. Presumably many of these had BE. However there were no statistics at all to determine, and no way of measuring, how many people in the general population had BE. Even today more and more people are being diagnosed with BE and, because is has already been labelled pre-cancerous, they are being treated for it. In many cases, the treatment is unnecessary!
- In 2011 a study of 8522 patients in Northern Ireland
- found that the rate of progression to cancer was only 2.2 people in 1000 per year: not a large number! Since PPIs are automatically prescribed for anyone suffering any diagnosis of BE, or simple reflux, it must be safe to assume that all these patients were on PPIs.
- In 2016 another large study was done, this time on no fewer than 796,492 adults. The paper was titled Maintenance proton pump inhibition therapy and risk of oesophageal cancer.
- Its aims were "to assess the risk of oesophageal adenocarcinoma among long-term PPI users relative to the corresponding background population."
- Its results: "Among all individuals using maintenance PPI therapy, the overall SIR of oesophageal adenocarcinoma was 3.93". Now SIR is Standardised Incidence Ratio - which is the the ratio of the results obtained divided by the expected results. In other words the chances of progression found in this study of 796,492 adults are nearly four times higher for PPI users than for non users!
- This paper concludes "In conclusion, the long term use of PPIs is associated with increased risk of oesophageal adenocarcinoma in the absence of other risk factors. Long term use of PPIs should be addressed with caution."
So the statistics, if you don't take PPIs, reduce to a progression rate of fewer than 6 people per 10,000 per year! This is an extremely low rate!
Medscape, a leading publisher of medical papers, comments on the above paper were "However, this "surprising" observation comes from a single cohort study that lacks the evidence to demonstrate a causal relationship, warn experts approached for comment."
However my own experiments with PPI dosage caused me to research the medical papers for explanations of effects I found that the consultants would not discuss. Read my explanation of how PPIs increase the cancer risk.
I have found, and listed many other medical papers that assess the risk of progression to cancer.
Barrett's in the general population
Barett's oesophagus has no symptoms of its own. People diagnosed with Barrett's have other problems - most commonly chronic heartburn or cough or ear problems. The Barrett's has developed from the same cause. It is clear then that if you didn't have these other problems your Barrett's would never have been diagnosed. It must be then that there are a large number of people who have undiagnosed Barretts and who never will be diagnosed. The facts above are from diagnosed cases. You can therefore dilute the scary factors above by a number nobody knows, but I would say at least halve them!
Remember that only a few people, even using PPIs, will ever get cancer. There is work being done to attempt to identify people who are at risk. The vast majority of us who have Barrett's oesophagus will not progress, so if PPIs make your life livable, the risks are low.
But if you do not need PPIs to make your life livable - then why are you taking them? I have a long segment Barrett's oesophagus - many studies say I am therefore at high risk. But a long segment logically implies a long time for it to develop. I do not now take PPIs (and have fewer symptoms as a result) and am not concerned about cancer.
There is a study that actually found that Esophageal cancer risk higher in medically treated GERD patients with fewest symptoms. This I cannot explain!
Your consultant has probably said you need to be on PPIs for life and may have said PPIs reduce the chances of progression. The internet has probably scared you silly! Consultants see problems initially. Very few of them see follow-up effects. People having problems with PPIs don't see consultants - they go to their GP. So the consultants necessarily get a skewed, biased view. My own father was a consultant and one piece of advice he gave my brother and I was "Stay away from people like me!"
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First published Monday the 2nd of July, 2018
Last modified:Sun, 10 Jan 2021 10:12:44 GMT
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