Radiofrequency ablation prevents progression of Barrett’s oesophagus to cancer

In Barrett’s oesophagus, the lining of the lower oesophagus is replaced by an intestinal type lining, a phenomenon known as intestinal metaplasia. A sham controlled multicentre trial of 127 participants has tested whether endoscopic radiofrequency ablation can eradicate intestinal metaplasia in patients with Barrett’s oesophagus and decrease the rate of neoplastic progression.⇑

After one year, 77.4% of the people who had been randomised to the ablation group had complete restoration of normal oesophageal lining, compared with 2.3% of people randomised to the control group. People who had received ablation treatment were also less likely to have disease progression (3.6% v 16.3%) and had fewer cancers (1.2% v 9.3%).

Success depended on the baseline severity of Barrett’s oesophagus. In those patients with low grade dysplasia, complete eradication was seen in 90.5% of those in the ablation group, compared with 22.7% of those in the control group. High grade dysplasia was completely eradicated in 81.0% of people in the ablation group and in 19.0% of those in the control group.

Radiofrequency ablation tops the treatment options that are currently available, says a linked editorial (pp 2353-55), but we still don’t know whether the procedure should be offered to people with non-dysplastic Barrett’s oesophagus.

Acid suppressants increase the risk of hospital acquired pneumonia

People who start taking acid suppressive drugs are known to be at increased risk of community acquired pneumonia during the first month of treatment. Despite this fact, prescribing of acid suppressive drugs is on the rise in hospitals. An estimated 40-70% of hospital patients are prescribed some type of acid suppressive therapy, half of whom are first prescribed this treatment in the hospital. A prospective cohort study of 63 878 people admitted to a large medical centre over 4 years now shows that people who take these drugs during their hospital stay are at increased risk of hospital acquired …