The Year in Gastroenterology: 10 Practice-Changing, Must-Read Studies

David A. Johnson, MD


December 20, 2017

A tremendous number of influential scientific publications have emerged this year in gastroenterology. Ten studies covering hot topics in the field and which are believed to best enhance patient management are reviewed.

Complications of Proton Pump Inhibitor Therapy

Vaezi MF, Yang YX, Howden CW
Gastroenterology. 2017;153:35-48

This analysis reviews the plethora of observational studies showing associations between proton pump inhibitors (PPIs) and adverse effects. The authors appropriately review the data and make evidence-based recommendations. They point out the lack of, or questionable biological explanations for, purported adverse effects; weak magnitudes of association and inconsistent results across different studies resulting in a high potential for confounding bias; and the absence of a dose/duration gradient of adverse effect.

Clinicians will find this article helpful for the frequent questions arising around the use of both prescribed and over-the-counter PPIs.


Disease Progression in Barrett's Low-Grade Dysplasia With Radiofrequency Ablation Compared With Surveillance: Systematic Review and Meta-analysis

Qumseya BJ, Wani S, Gendy S, Harnke B, Bergman JJ, Wolfsen H
Am J Gastroenterol. 2017;112:849-865

The management strategies for patients with Barrett esophagus (BE) and low-grade dysplasia (LGD) remain controversial.

Recent "best-practice" recommendations state that a histologic diagnosis of LGD needs to be confirmed by a recognized expert pathologist, that high-definition endoscopy should be conducted in 8-12 weeks after twice-daily PPI treatment, and that endoscopic ablation by radiofrequency ablation (RFA) should be used for all patients with confirmed and persistent LGD.

This systematic review and meta-analysis involving approximately 3000 patients with BE and LGE compared risks for progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) associated with RFA versus standard surveillance biopsies. They reported that the cumulative rate of progression to HGD/EAC was significantly lower with RFA versus surveillance (1.7% vs 12.6%; relative risk, 0.14; number needed to treat with RFA to prevent 1 case of disease progression, 9.2). These results suggest that for BE patients with persistent LGD, RFA (notably after endoscopic resection of any visible mucosal abnormalities) appears to have emerged as the new standard of care.


How I Approach the Management of Eosinophilic Esophagitis in Adults

Hirano I
Am J Gastroenterol. 2017;112:197-199

This review by a notable expert in the field offers pragmatic clinical pearls for managing eosinophilic esophagitis (EoE).

As the optimal management of EoE continues to evolve, these practical recommendations provide useful guidance to clinicians who deal with this increasingly prevalent disease.



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