Lack of incremental effect of histamine receptor antagonists over proton pump inhibitors on the risk of neoplastic progression in patients with B arrett's esophagus: a cohort study

OBJECTIVE Long‐term acid suppression reduces the risk of progression to esophageal adenocarcinoma ( EAC ) in patients with B arrett's esophagus ( BE ). Given recent reports about the harmful effects of using chronic proton pump inhibitors ( PPI ) there is renewed interest in alternative methods of acid suppression. Hence, we studied the effect of H 2 receptor antagonists ( H 2 RA ) on the risk of progression to neoplasia in our BE cohort. METHODS This is a retrospective analysis of prospectively collected data of patients in our BE r egistry from 2002 to 2015. Patients' characteristics, endoscopic findings, such as the length of BE , hiatal hernia size and histological findings and patients' use of medications such as PPI , aspirin, H 2 RA , metformin and antihyperlipidemic agents were studied. RESULTS The cohort consisted of 1466 patients with a mean age of 61 ± 13 years. The patients had a predominance of male sex (76.7% [1118/1457]) and Caucasian race (96.6% [1209/1252]). After excluding prevalent high‐grade dysplasia ( HGD ) or EAC , 1025 patients had a median follow up of 43.6 months during which 57 patients progressed to HGD or EAC . PPI use (56% in progressors vs 69% in non‐progressors; P = 0.007) but not H 2 RA use (12% progressors vs 19% in non‐progressors P = 0.162) was associated with lower risk of neoplastic progression. On multivariate analysis, there was no synergistic effect of addition of H 2 RA to PPI on risk of neoplastic progression to HGD or EAC (relative risk 0.33; confidence intervals 0.05–2.29, P = 0.262). CONCLUSION H 2 RA do not seem to have a chemopreventive role in patients with BE .