*The Role of Proton Pump Inhibitors in the Treatment of Barrett's Esophagus DOI: http://dx.doi.org/10.5772/intechopen.111394*

Recent studies show that nonsteroidal anti-inflammatory drugs (NSAIDS), such as aspirin, have shown evidence of preventing esophageal cancer in people with BE [22, 23]. However, none of these studies have provided reliable evidence for the effect of these drugs in the prevention of esophageal adenocarcinoma in the field of BE.

BE is thought to be the result of esophageal epithelium in response to damage. The development of BE is a consequence of long-term GERD. Barrett's epithelium, due to its specific histological features, can be expected to be more resistant to aggressive acidic stomach contents. Diagnosis of Barrett's patients always requires histological confirmation to allow better monitoring of patients, according to the degree of change in Barrett's patients.


*Legend: HP – histopathologic type, IM – intestinal metaplasia, LGD - low grade dysplasia, HGD – high grade dysplasia.*

## **Table 1.**

*Structure of patients with BE at the beginning of the study.*


## **Table 2.**

*Evaluation of patients with BE after 2 years of treatment.*


*Dmax = 0.32 > D (39;0.01) = 0.26 and P < 0.01.*

*LSBE: Dmax = 0.06 < D (11;0.05) = 0.391 and P > 0.05.*

## **Table 3.**

*Evaluation of patients with BE by endoscopic type.*

The PPI class is the most potent type of acid suppression therapy. PPIs are replaced by benzimidazoles that continuously bind H + K + ATP as the final step in gastric acid secretion. Group members include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. Standard doses of each type of drug may have a similar inhibitory effect. Omeprazole is the longest documented agent, while newer agents, rabeprazole and pantoprazole, have less interaction than both with the cytochrome P450 metabolism. Several studies have shown the superiority of PPI over H2RAs in the treatment of reflux esophagitis.

Of the 50 patients with BE according to histopathological type, 40 or 80.0% were IM, 10 or 20% were LGD and there was no case of HGD (**Table 1**).

Out of the 40 IM patients included in our study, after 2 years of treatment, only 20 patients or 50.0% had IM, 4 or 10.0% had LGD and 16 patients or 40.0% had NERD. Of the 10 patients with LGD after 2 years of treatment, only 5 patients or 50.0% had LGD, 2 patients or 20.0% had IM, and 3 patients or 30.0% had NERD (non-erosive reflux disease) (**Table 2**).

Patients of the endoscopic type Long segment of Barrett's esophagus (LSBE) have a more frequent progression of 27.3% compared with 2.6% to patients of the endoscopic type Short Segment of Barrett's esophagus (SSBE) 2.6% difference with significant statistical significance (Z = −2.66, P = 0.0078), (**Table 3**).

With the Kolmogar-Smirn test, we confirmed a statistically significant difference in the regressions of changes in BE, when we have to do with SSBE (P < 0.05 and 0.01), but also not a significant difference in the evolution of changes in BE, progression, or regression, when we have to do with LSBE (P > 0.05) (**Figure 4**).

The correlation of histopathological type and disease regression in patients with BE, in our study, did not result in a significant difference (Fisher Exact test, P = 0.487). From the group with intestinal metaplasia, 40.0% of patients and 50.0% of patients in the LGD (low-grade dysplasia) group had regression (**Figure 5**, **Table 4**).

Of the 70 patients with GERD regression, we had 40 or 57.1%, and of the 50 patients with BE regression we had 21 or 42.0% difference without any statistically significant value (P = 0.138), 34.3% of patients with GERD was stable and 50.0% of patients with BE without significant difference (P = 0.05), and we had progression in

**Figure 4.** *Regression in patients with BE by endoscopic type [24].*

*The Role of Proton Pump Inhibitors in the Treatment of Barrett's Esophagus DOI: http://dx.doi.org/10.5772/intechopen.111394*

## **Figure 5.**

*Regression in patients with BE by histopathological type [24].*


## **Table 4.**

*Regression among patients with BE according to histopathological type.*

8.6% of patients with GERD and 8.0% of patients with BE without significant difference (P = 1.00).

Also with the Fisher test, we did not get a significant difference between the groups (P = 1.00) according to the degree of progression.

However, there is a significant intra-group difference between the two groups, where patients with regression and stable changes after IPP treatment visibly dominate over those with progression. The test was performed with the Colmogar-Smirn test for one sample.

After treatment of patients with PPI, there was more regression of the disease in patients with GERD than in those with BE (**Table 5**).
