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The following research report reached a conclusion that seems to be contrary to logic, (namely that fewer symptoms indicate a greater risk). Anyone with half a brain can see that such a conclusion is not only counterintuitive, but probably impossible, in the real world. Again, this is a case of the researchers trumpeting an important discovery, while being blind to the real issue at hand.
The risk for esophageal adenocarcinogenesis is significantly higher in medically treated patients with mild or absent symptoms of gastroesophageal reflux disease (GERD) vs those with severe symptoms, according to the results of a cross-sectional study reported in the July issue of the Archives of Surgery.
"Screening for esophageal adenocarcinoma has focused on identifying Barrett esophagus (BE) in patients with severe, longstanding symptoms of ...GERD," write Katie S. Nason, MD, MPH, from the Division of Thoracic and Foregut Surgery, University of Pittsburgh in Pittsburgh, Pennsylvania, and colleagues. "Unfortunately, 95% of patients who develop esophageal adenocarcinoma are unaware of the presence of BE before their cancer diagnosis, which means they never had been selected for screening. One possible explanation is that no correlation exists between the severity of GERD symptoms and cancer risk."
I have a hunch that the key words here are "medically treated", and or "PPI". Note that the study involved only patients who were treated, (with a PPI), and did not consider patients who remain untreated. Why were they excluded? Don't they have a higher risk of adverse results?Among patients taking PPIs, those with no severe typical or atypical GERD symptoms were 61.3% and 81.5% more likely to have adenocarcinogenesis, respectively, than patients who reported that all symptoms were severe.
Maybe not, IMO. Here's what I believe is going on here:
Since the research involved only patients who were taking a PPI, then obviously the PPI has to be the dominant influence in the outcome. Apparently, it has a very dangerous effect, that the researchers completely overlooked - namely, it masks the symptoms of GERD, but it does little to limit the actual damage to the esophagus, and by weakening the lower esophageal sphincter, PPI's actually make reflux more likely, and thereby increase the risk of esophageal adenocarcinoma. Note that this is strictly my opinion, and there is no official scientific research to back it up. However, reading between the lines of research reports such as this one, certainly points a finger in that direction.
Well, actually, proof that PPIs weaken the lower esophageal sphincter, thus increasing the likelihood of reflux, does exist - I've posted links to that research previously. As far as limiting the damage due to reflux is concerned, PPIs do raise the pH of the stomach contents, but the pH remains low enough to burn the esophageal tissue, it's just not as painful to the patient, (so it is usually overlooked). The fact that reflux occurs more frequently, or almost constantly, (due to a weakened lower esophageal sphincter), also makes the condition less noticeable to the patient - we become used to such low-level issues, so that over time, we are not as likely to notice them, due to lowered sensitivity. It becomes a "mild" symptom, or we may not even feel it at all.
In fact, if you think about it, it's pretty clear what's going on. Some patients do not respond to PPIs, (or they respond very weakly), and so their symptoms are mostly unresolved. Clearly, if their symptoms are still severe, the PPI is not working, so their digestive system is only weakly affected by the drug. They may not realize it, but they are the lucky ones, (again, IMO).
For patients whose symptoms are well-controlled by a PPI, obviously, the drug is "working" as designed, and so it can be concluded that the PPI is strongly "effective" for them. Obviously, the more effective the PPI, the more damage is done to the esophagus, (and unfortunately, the patient and doctor are unaware of the damage, because the patient's clinical symptoms appear to be well controlled). It's a no-brainer. As I have maintained for years - not only is the use of PPIs counterproductive, but now it is clear that they are dangerous drugs, as well. Plus, the dang things trigger MC, for some people, so there are plenty of reasons not to take them.
Personally, I can see no good reason why anyone would want to take them, but doctors absolutely love them, and will prescribe them for anyone, in a heartbeat. Please don't allow yourself to fall into that trap.
http://www.medscape.com/viewarticle/746755
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