August's issue of Gut contains a meta-analysis that shows a 71% reduction in the risk of oesophageal cancer in patients with Barrett's oesophagus. Whether symptomatic or not, it seems that this group should be on longterm PPI therapy - but this is already the case. More interestingly, and much more controversially, is the question of whether people with reflux symptoms (but no endoscopic diagnosis) should be on the drug. Do PPIs prevent you getting cancer if you have reflux but not Barrett's?
There is much less decent information on this topic. Certainly one cannot say a resounding 'yes'. Indeed logically, the fact that they are the second most prescribed drug in this country (after statins) and we are still seeing an alarming rise in the incidence of oesophageal cancer, one could be forgiven for thinking the answer is clearly 'no'. Certainly longterm use has been linked to multiple vitamin amd mineral deficiencies and a higher rate of pneumonias and Clostridium Difficile infections. Ironically, one of the main problems is that they are too good at treating the symptoms of reflux but leaving the cause untreated. If one's life-disrupting symptoms of heartburn have gone, what is the incentive to still address those tiresome lifestyle issues that would take far more effort to turn around than just the popping of a daily pill?
More on this shortly.