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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng231er2-lrg.png" alt="Cover of Evidence review for pharmacological interventions to reduce progression to dysplasia or cancer" /></a></div><div class="bkr_bib"><h1 id="_NBK595771_"><span itemprop="name">Evidence review for pharmacological interventions to reduce progression to dysplasia or cancer</span></h1><div class="subtitle">Barrett’s oesophagus and stage 1 oesophageal adenocarcinoma</div><p><b>Evidence review B</b></p><p><i>NICE Guideline, No. 231</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2023 Feb</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-5008-9</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div></div><div class="bkr_clear"></div></div><div id="niceng231er2.s1"><h2 id="_niceng231er2_s1_">1. Pharmacological interventions to reduce progression to dysplasia or cancer</h2><div id="niceng231er2.s1.1"><h3>1.1. Review question</h3><p>For adults with Barrett’s oesophagus, what is the clinical and cost effectiveness of pharmacological interventions (such as antacids, aspirin, H2 receptor antagonists, proton pump inhibitors) in reducing progression to dysplasia or cancer?</p><div id="niceng231er2.s1.1.1"><h4>1.1.1. Introduction</h4><p>For people with Barrett’s Oesophagus, medical management with pharmacological interventions is routinely used. Pharmacological interventions have been associated with a reduction in the risk of cancer progression, but there remains a debate with regards risk versus benefit of aspirin. It is important to understand how beneficial these agents are in preventing progression of Barrett’s and this review aims to find out the clinical and cost effectiveness of these medications in reducing progression to dysplasia or cancer.</p></div><div id="niceng231er2.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng231er2.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab1"><a href="/books/NBK595771/table/niceng231er2.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab1" rid-ob="figobniceng231er2tab1"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab1/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab1"><a href="/books/NBK595771/table/niceng231er2.tab1/?report=objectonly" target="object" rid-ob="figobniceng231er2tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng231er2.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng231er2.appa">appendix A</a> and the <a href="/books/NBK595771/bin/methods-pdf-11371337245.pdf">methods</a> document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng231er2.s1.1.4"><h4>1.1.4. Effectiveness evidence</h4><div id="niceng231er2.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>Two RCTs were included in the review <a class="bibr" href="#niceng231er2.s1.1.ref1" rid="niceng231er2.s1.1.ref1"><sup>1</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng231er2.s1.1.ref2" rid="niceng231er2.s1.1.ref2"><sup>2</sup></a> these are summarised in <a class="figpopup" href="/books/NBK595771/table/niceng231er2.tab2/?report=objectonly" target="object" rid-figpopup="figniceng231er2tab2" rid-ob="figobniceng231er2tab2">Table 2</a> below. Both the studies included people with low grade dysplasia in Barrett’s oesophagus.</p><p>One study compared three different Proton Pump Inhibitors (PPI) pantoprazole, lansoprazole, or omeprazole, examining the degree of dysplasia after one year of follow up. The second study compared high dose vs low dose PPI and aspirin vs no aspirin on a sample of participants randomised to four different groups using a 2x2 factorial design to receive either high or low dose PPI with or without aspirin. Participants were followed up for a median of 8.9 years and outcomes included all-cause mortality, oesophageal adenocarcinoma, and high-grade dysplasia. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK595771/table/niceng231er2.tab3/?report=objectonly" target="object" rid-figpopup="figniceng231er2tab3" rid-ob="figobniceng231er2tab3">Table 3</a>).</p><p>No relevant clinical studies examining antacids, NSAIDs, H2 receptor antagonists or statins were identified.</p><p>See also the study selection flow chart in <a href="#niceng231er2.appc">Appendix C</a>, study evidence tables in <a href="#niceng231er2.appd">Appendix D</a>, forest plots in <a href="#niceng231er2.appe">Appendix E</a> and GRADE tables in <a href="#niceng231er2.appf">Appendix F</a>.</p></div><div id="niceng231er2.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng231er2.apph">Appendix H</a>.</p></div></div><div id="niceng231er2.s1.1.5"><h4>1.1.5. Summary of studies included in the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab2"><a href="/books/NBK595771/table/niceng231er2.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab2" rid-ob="figobniceng231er2tab2"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab2/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab2/?report=previmg" alt="Table 2. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab2"><a href="/books/NBK595771/table/niceng231er2.tab2/?report=objectonly" target="object" rid-ob="figobniceng231er2tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng231er2.appd">Appendix D</a> for full evidence tables.</p></div><div id="niceng231er2.s1.1.6"><h4>1.1.6. Summary of the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab3"><a href="/books/NBK595771/table/niceng231er2.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab3" rid-ob="figobniceng231er2tab3"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab3/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab3/?report=previmg" alt="Table 3. Clinical evidence summary: High dose PPI compared to Low dose PPI for Barrett’s Oesophagus." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab3"><a href="/books/NBK595771/table/niceng231er2.tab3/?report=objectonly" target="object" rid-ob="figobniceng231er2tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: High dose PPI compared to Low dose PPI for Barrett’s Oesophagus. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab4"><a href="/books/NBK595771/table/niceng231er2.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab4" rid-ob="figobniceng231er2tab4"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab4/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab4/?report=previmg" alt="Table 4. Clinical evidence summary: Aspirin compared to no Aspirin for Barrett’s Oesophagus." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab4"><a href="/books/NBK595771/table/niceng231er2.tab4/?report=objectonly" target="object" rid-ob="figobniceng231er2tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Aspirin compared to no Aspirin for Barrett’s Oesophagus. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab5"><a href="/books/NBK595771/table/niceng231er2.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab5" rid-ob="figobniceng231er2tab5"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab5/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab5/?report=previmg" alt="Table 5. Clinical evidence summary: Pantoprazole compared to Lansoprazole for Barrett’s Oesophagus." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab5"><a href="/books/NBK595771/table/niceng231er2.tab5/?report=objectonly" target="object" rid-ob="figobniceng231er2tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Pantoprazole compared to Lansoprazole for Barrett’s Oesophagus. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab6"><a href="/books/NBK595771/table/niceng231er2.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab6" rid-ob="figobniceng231er2tab6"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab6/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab6/?report=previmg" alt="Table 6. Clinical evidence summary: Lansoprazole compared to Omeprazole for Barrett’s Oesophagus." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab6"><a href="/books/NBK595771/table/niceng231er2.tab6/?report=objectonly" target="object" rid-ob="figobniceng231er2tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Lansoprazole compared to Omeprazole for Barrett’s Oesophagus. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab7"><a href="/books/NBK595771/table/niceng231er2.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab7" rid-ob="figobniceng231er2tab7"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab7/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab7/?report=previmg" alt="Table 7. Clinical evidence summary: Pantoprazole compared to Omeprazole for Barrett’s Oesophagus." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab7"><a href="/books/NBK595771/table/niceng231er2.tab7/?report=objectonly" target="object" rid-ob="figobniceng231er2tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Pantoprazole compared to Omeprazole for Barrett’s Oesophagus. </p></div></div><p>See <a href="#niceng231er2.appf">Appendix F</a> for full GRADE tables.</p></div><div id="niceng231er2.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng231er2.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng231er2.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng231er2.appg">Appendix G</a>.</p></div></div><div id="niceng231er2.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><p>There was no economic evidence found.</p></div><div id="niceng231er2.s1.1.9"><h4>1.1.9. Economic model</h4><p>This area was prioritised for new cost-effectiveness analysis. However, original economic modelling was not conducted due to a lack of robust clinical evidence.</p></div><div id="niceng231er2.s1.1.10"><h4>1.1.10. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2tab8"><a href="/books/NBK595771/table/niceng231er2.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2tab8" rid-ob="figobniceng231er2tab8"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.tab8/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.tab8/?report=previmg" alt="Table 8. Unit cost of drugs." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.tab8"><a href="/books/NBK595771/table/niceng231er2.tab8/?report=objectonly" target="object" rid-ob="figobniceng231er2tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Unit cost of drugs. </p></div></div></div><div id="niceng231er2.s1.1.11"><h4>1.1.11. The committee’s discussion and interpretation of the evidence</h4><div id="niceng231er2.s1.1.11.1"><h5>1.1.11.1. The outcomes that matter most</h5><p>To understand the clinical effectiveness of pharmacological interventions in reducing progression to dysplasia or cancer, the committee considered the outcomes of mortality (including all-cause mortality), health related quality of life, progression from non-dysplastic to low grade dysplasia, progression to any grade of dysplasia, progression to high grade dysplasia or cancer and adverse events. All outcomes in this review were equally important in decision making and were therefore rated as critical by the committee.</p><p>Evidence was identified for the outcomes of mortality (all-cause and cause-specific mortality), progression to low-grade dysplasia, progression to high-grade dysplasia and oesophageal adenocarcinoma and serious adverse events. No evidence was identified for the outcome of health-related quality of life.</p></div><div id="niceng231er2.s1.1.11.2"><h5>1.1.11.2. The quality of the evidence</h5><p>Evidence from two RCTs meeting the review protocol was identified, with one RCT examining the clinical effectiveness of three different PPIs (pantoprazole, lansoprazole, or omeprazole) and one RCT comparing high dose to low dose PPI and aspirin to no aspirin.</p><p>No relevant clinical studies examining the clinical effectiveness of antacids, NSAIDs, H2 receptor antagonists or statins for the outcomes prespecified were identified.</p><p>For the comparisons of different PPIs (pantoprazole, lansoprazole, or omeprazole), there was evidence for the outcomes of low and high-grade dysplasia, the quality of which was very low. Evidence was downgraded for risk of bias that was due to limited information regarding the methodology, analysis, and patient characteristics. Evidence was also downgraded due to population indirectness as the study included participants who had dysplasia at baseline and imprecision in the effect estimates with confidence intervals being very wide.</p><p>The quality of the evidence for high vs low dose PPI and aspirin vs no aspirin was low for the outcomes of cause-specific mortality and oesophageal adenocarcinoma due to very serious imprecision with the confidence intervals being very wide and moderate for the outcomes of all-cause mortality, high-grade dysplasia, due to serious imprecision based on the confidence interval around the effect estimates. The quality of the evidence for the outcome of serious adverse events was high for the high vs low dose PPI comparison and moderate for the aspirin vs no aspirin comparison, the latter being downgraded due to serious imprecision.</p></div><div id="niceng231er2.s1.1.11.3"><h5>1.1.11.3. Benefits and harms</h5><p>No relevant clinical studies on antacids, NSAIDs, H2 receptor antagonists or statins were identified and in the included evidence on PPIs and aspirin there was no comparison between drug classes.</p><p>The evidence comparing different PPIs showed no clinically important difference for any PPI (pantoprazole, lansoprazole, or omeprazole) over the other. The committee noted that because the evidence comparing different PPIs was from an underpowered RCT and was of very low quality with very wide confidence intervals it was not possible to draw conclusions regarding the effect estimates. The committee also noted that the length of follow up (1 year) in the study was too short for any clinically important change to occur. The committee agreed that the evidence for different PPIs was too limited both in terms of quantity and quality to base any recommendations on.</p><p>Evidence comparing high dose PPI with low dose PPI, also showed there was no clinically important difference across the outcomes examined. However, the committee noted that although the absolute effects did not meet the thresholds for clinical importance, the direction of the effect favoured high dose PPI over low dose PPI for the outcome of all-cause mortality. The committee noted this was also the case for most of the other outcomes examined except for serious adverse events. Despite not reaching the threshold for clinical importance, the committee emphasised that a higher dose of PPI was not associated with a higher number of adverse events or cases of all-cause mortality. The committee discussed that, although treatment with PPI might have chemo-preventive effects against oesophageal adenocarcinoma compared to no treatment, this would be difficult to demonstrate within a clinical trial setting as a placebo-controlled trial is not feasible as most people with Barrett’s oesophagus need treatment with PPI. There was consensus that the current evidence did not support a recommendation for the use of PPIs in preventing progression to dysplasia and oesophageal cancer.</p><p>For the comparison of aspirin with no aspirin, evidence showed no clinically important difference across the outcomes examined. The committee noted that despite not meeting thresholds for clinical importance, the point estimates for all-cause mortality and high-grade dysplasia favoured aspirin compared to no aspirin. However, there was a greater number of serious adverse events with aspirin compared to no aspirin. Although the effect was not clinically important, the committee noted this was in line with their experience as a greater number of adverse events such as bleeding, is likely to be seen in people treated with aspirin compared to no aspirin. The committee emphasised that in the current trial, the lack of a clinically important effect favouring no aspirin in terms of adverse events could be attributed to a protective effect from PPIs taken by people in both the aspirin and no aspirin groups.</p><p>The committee discussed that although there is some effect observed in terms of all-cause mortality and high-grade dysplasia in both the comparisons of high vs low dose PPI and aspirin vs no aspirin, the length of follow up, despite being 8.5 years, may not have been sufficient to capture progression to high-grade dysplasia. Therefore, the lack of a clinically important effect within the duration of this study did not allow the committee to draw conclusions, as they noted based on their experience that it may take longer for pharmacological interventions to act on cancer risk. The committee agreed that there was no sufficient evidence to recommend aspirin as a chemo-preventive treatment for Barrett’s oesophagus. Considering their clinical experience that was in line with evidence showing a greater number of adverse events associated with aspirin, the committee concluded a recommendation should be made against offering aspirin to prevent progression of dysplasia or and cancer.</p><p>The committee agreed that, based on the current limited evidence base (coming from one study and showing no clinically important results), the use of neither high dose PPI nor Aspirin can be recommended.</p><p>The committee agreed that PPI treatment is widely used for symptom control for patients with Barrett’s oesophagus but not for chemoprevention. They noted, the current evidence does not justify a recommendation for high dosage PPI but agreed based on clinical experience that acid-suppressant medication such as PPI should be offered to all patients to control symptoms of gastro-oesophageal reflux, although the dose should be reviewed regularly to prevent potential long-term side effects such as bone fractures, infections, and electrolyte disturbances. They agreed to cross reference to the recommendations on managing gastro-oesophageal reflux disease in the NICE guideline on gastro-oesophageal reflux disease and dyspepsia in adults.</p></div><div id="niceng231er2.s1.1.11.4"><h5>1.1.11.4. Cost effectiveness and resource use</h5><p>There are recurrent costs and side effects associated with drug treatments, but they might be justified by improved quality of life through symptom control or through reduced progression of disease.</p><p>No economic evaluations were identified for this question.</p><p>The clinical evidence for aspirin versus no aspirin suggested no clinically important benefit, with an increase in serious adverse events with aspirin, though this was clinically unimportant. Overall, the committee decided there was insufficient clinical evidence to inform the cost effectiveness of aspirin as a chemo-preventative agent in Barrett’s.</p><p>The clinical evidence for PPIs suggested a trend towards improved survival with high dose PPI versus low dose PPI with a clinically unimportant difference in serious adverse events. The committee did not think the evidence was strong enough to show if <u>high-dose</u> PPIs are effective for chemoprevention, and therefore their cost effectiveness is uncertain.</p></div></div><div id="niceng231er2.s1.1.12"><h4>1.1.12. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendation 1.2.2.</p></div><div id="niceng231er2.s1.1.rl.r1"><h4>1.1.13. References</h4><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng231er2.s1.1.ref1">Babic
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Z, Bogdanovic
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Z, Dorosulic
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Z, Petrovic
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Z, Kujundzic
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M, Banic
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M
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et al. One year treatment of Barrett’s oesophagus with proton pump inhibitors (a multi-center study). Acta Clinica Belgica. 2015
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70(6):408–413 [<a href="https://pubmed.ncbi.nlm.nih.gov/26790552" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26790552</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="niceng231er2.s1.1.ref2">Jankowski
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JAZ, de Caestecker
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J, Love
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SB, Reilly
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G, Watson
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P, Sanders
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S
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et al. Esomeprazole and aspirin in Barrett’s oesophagus (AspECT): A randomised factorial trial. Lancet. 2018
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392(10145):400–408 [<a href="/pmc/articles/PMC6083438/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6083438</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30057104" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30057104</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="niceng231er2.s1.1.ref3">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated January 2022]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a></div></dd></dl></dl></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng231er2.appa"><h3>Appendix A. Review protocols</h3><p id="niceng231er2.appa.et1"><a href="/books/NBK595771/bin/niceng231er2-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for pharmacological interventions to reduce progression to dysplasia or cancer</a><span class="small"> (PDF, 189K)</span></p><p id="niceng231er2.appa.et2"><a href="/books/NBK595771/bin/niceng231er2-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic review protocol</a><span class="small"> (PDF, 132K)</span></p></div><div id="niceng231er2.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual.<a class="bibr" href="#niceng231er2.s1.1.ref3" rid="niceng231er2.s1.1.ref3"><sup>3</sup></a></p><p>For more information, please see the Methodology review published as part of the accompanying documents for this guideline.</p><p id="niceng231er2.appb.et1"><a href="/books/NBK595771/bin/niceng231er2-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.1. Clinical search literature search strategy</a><span class="small"> (PDF, 165K)</span></p><p id="niceng231er2.appb.et2"><a href="/books/NBK595771/bin/niceng231er2-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">B.2. Health Economics literature search strategy</a><span class="small"> (PDF, 140K)</span></p></div><div id="niceng231er2.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng231er2.appc.et1"><a href="/books/NBK595771/bin/niceng231er2-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 1. Flow chart of clinical study selection for the review of Pharmacological interventions in reducing progression to cancer or dysplasia</a><span class="small"> (PDF, 65K)</span></p></div><div id="niceng231er2.appd"><h3>Appendix D. Effectiveness evidence</h3><p id="niceng231er2.appd.et1"><a href="/books/NBK595771/bin/niceng231er2-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (282K)</span></p></div><div id="niceng231er2.appe"><h3>Appendix E. Forest plots</h3><p id="niceng231er2.appe.et1"><a href="/books/NBK595771/bin/niceng231er2-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (183K)</span></p></div><div id="niceng231er2.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng231er2.appf.et1"><a href="/books/NBK595771/bin/niceng231er2-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (215K)</span></p></div><div id="niceng231er2.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng231er2.appg.et1"><a href="/books/NBK595771/bin/niceng231er2-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (129K)</span></p></div><div id="niceng231er2.apph"><h3>Appendix H. Excluded studies</h3><div id="niceng231er2.apph.s1"><h4>Clinical studies</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng231er2apphtab1"><a href="/books/NBK595771/table/niceng231er2.apph.tab1/?report=objectonly" target="object" title="Table 16" class="img_link icnblk_img figpopup" rid-figpopup="figniceng231er2apphtab1" rid-ob="figobniceng231er2apphtab1"><img class="small-thumb" src="/books/NBK595771/table/niceng231er2.apph.tab1/?report=thumb" src-large="/books/NBK595771/table/niceng231er2.apph.tab1/?report=previmg" alt="Table 16. Studies excluded from the clinical review." /></a><div class="icnblk_cntnt"><h4 id="niceng231er2.apph.tab1"><a href="/books/NBK595771/table/niceng231er2.apph.tab1/?report=objectonly" target="object" rid-ob="figobniceng231er2apphtab1">Table 16</a></h4><p class="float-caption no_bottom_margin">Studies excluded from the clinical review. </p></div></div></div><div id="niceng231er2.apph.s2"><h4>Health Economic studies</h4><p>Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.</p><p>None.</p></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review underpinning recommendation 1.2.2 in the NICE guideline</p><p>National Institute for Health and Care Excellence</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2023.</div><div class="small"><span class="label">Bookshelf ID: NBK595771</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/37816096" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">37816096</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng231er2tab1"><div id="niceng231er2.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng231er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng231er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults, 18 years and over, with non-dysplastic Barrett’s oesophagus and low-grade dysplasia in Barrett’s oesophagus</td></tr><tr><th id="hd_b_niceng231er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng231er2.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Antacids</div></li><li class="half_rhythm"><div>NSAIDs</div></li><li class="half_rhythm"><div>Aspirin</div></li><li class="half_rhythm"><div>H2 receptor antagonists</div></li><li class="half_rhythm"><div>Proton Pump Inhibitors</div></li><li class="half_rhythm"><div>Statins (e.g., simvastatin)</div></li></ul></td></tr><tr><th id="hd_b_niceng231er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparisons</th><td headers="hd_b_niceng231er2.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Each other</div></li><li class="half_rhythm"><div>Within class comparison</div></li><li class="half_rhythm"><div>Combination therapy (e.g., PPI + Aspirin combination vs. singular medicine)</div></li><li class="half_rhythm"><div>Low dose vs. high dose of medication (same medication)</div></li><li class="half_rhythm"><div>No treatment</div></li></ul></td></tr><tr><th id="hd_b_niceng231er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng231er2.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Mortality (including all-cause mortality)</div></li><li class="half_rhythm"><div>Health related quality of life</div></li><li class="half_rhythm"><div>Progression from non-dysplastic to low grade dysplasia</div></li><li class="half_rhythm"><div>Progression to any grade of dysplasia</div></li><li class="half_rhythm"><div>Progression to high grade dysplasia or cancer</div></li><li class="half_rhythm"><div>Adverse events (e.g., bleeding)</div></li></ul></td></tr><tr><th id="hd_b_niceng231er2.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng231er2.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>RCT</div></li><li class="half_rhythm"><div>SR of RCT’s</div></li><li class="half_rhythm"><div>Published NMAs and IPDs will be considered for inclusion.</div></li></ul></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng231er2tab2"><div id="niceng231er2.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng231er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng231er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_niceng231er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng231er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng231er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Babic 2015 <a class="bibr" href="#niceng231er2.s1.1.ref1" rid="niceng231er2.s1.1.ref1"><sup>1</sup></a></td><td headers="hd_h_niceng231er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>PPI medication:</p>
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<p>Pantoprazole (N = 54) dose of 40mg twice a day during 10weeks</p>
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<p>vs</p>
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<p>Lansoprasole (N = 36) dose of 30mg twice a day during 10 weeks, then 30mg once a day to the end of the study</p>
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<p>vs</p>
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<p>Omeprazole (N = 30) dose of 40mg twice a day for 10weeks, then 40mg once a day</p>
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</td><td headers="hd_h_niceng231er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Patients with Barrett’s oesophagus diagnosed by endoscopy and histological analysis of the tissue biopsy specimen</p>
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<p>N=120 mean age (SD): 52.3 (14.4) years</p>
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<p>Croatia</p>
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</td><td headers="hd_h_niceng231er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Indefinite dysplasia</p>
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<p>Low-grade dysplasia</p>
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<p>High-grade dysplasia</p>
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<p>Follow up: 1 year</p>
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</td><td headers="hd_h_niceng231er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">One patient in each Treatment group showed worsening and progression to higher grade of dysplasia at baseline.</td></tr><tr><td headers="hd_h_niceng231er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Jankowski 2018 <a class="bibr" href="#niceng231er2.s1.1.ref2" rid="niceng231er2.s1.1.ref2"><sup>2</sup></a></td><td headers="hd_h_niceng231er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>High or low dose PPI with or without aspirin.</p>
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<p>High dose PPI: Esomeprazole (40 mg capsules twice daily; n=1270)</p>
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<p>Vs</p>
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<p>low dose (20 mg capsules once daily; n=1265).</p>
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<p>Aspirin (300 mg in the UK, 325 mg in Canada; n=1138)</p>
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<p>Vs</p>
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<p>No aspirin (n=1142).</p>
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<p>Study comparison groups:
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1)</dt><dd><p class="no_top_margin">High dose PPI vs low dose PPI (in each group there was an approximately equal number of people who did or did not receive aspirin)</p></dd></dl><dl class="bkr_refwrap"><dt>2)</dt><dd><p class="no_top_margin">Aspirin vs no aspirin (in each group there was an approximately equal number of people who received high and low dose PPI medication)</p></dd></dl></dl></p>
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</td><td headers="hd_h_niceng231er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>People aged ≥18 years with circumferential Barrett’s oesophagus of at least 1 cm in length (≥C1M1) or a tongue of Barrett’s oesophagus of at least 2 cm in length (≥C0M2), irrespective of the presence now or historically of histologically proven intestinal metaplasia.</p>
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<p>Countries: England, Scotland, Wales, and Northern Ireland, and one in McMaster Health Sciences Centre, Hamilton, ON, Canada</p>
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</td><td headers="hd_h_niceng231er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>All-cause mortality</p>
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<p>Cause-specific mortality</p>
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<p>High-grade dysplasia</p>
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<p>Oesophageal adenocarcinoma</p>
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<p>Serious adverse events(Blood and lymphatic system disorders, cardiac disorders, ear and labyrinth disorders, endocrine disorders, eye disorders, gastrointestinal disorders, general disorders and administration site conditions, hepatobiliary disorders, immune system disorders, infections and infestations, injury, poisoning, and procedural complications investigations, metabolism and nutrition disorders, musculoskeletal and connective tissue disorders, neoplasms benign, malignant, and unspecified (including cysts and polyps, nervous system disorders, psychiatric disorders, renal and urinary disorders, respiratory, thoracic, and mediastinal disorders, skin and subcutaneous tissue disorders, vascular disorders)</p>
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<p>Follow up: Median 8.9 years</p>
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</td><td headers="hd_h_niceng231er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Participants in the AspECT trial were randomised using a 2×2 factorial design to receive high or low dose PPI with or without aspirin.</p>
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<p>Results were reported separately for the comparisons of low vs high dose PPI and aspirin vs no aspirin.</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng231er2tab3"><div id="niceng231er2.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: High dose PPI compared to Low dose PPI for Barrett’s Oesophagus</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng231er2.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng231er2.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">
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<p>№ of participants</p>
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<p>(studies)</p>
|
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<p>Follow-up</p>
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</th><th id="hd_h_niceng231er2.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">
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<p>Certainty of the evidence</p>
|
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<p>(GRADE)</p>
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</th><th id="hd_h_niceng231er2.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">
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<p>Relative effect</p>
|
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<p>(95% CI)</p>
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</th><th id="hd_h_niceng231er2.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng231er2.tab3_1_1_1_5" id="hd_h_niceng231er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Low dose PPI</th><th headers="hd_h_niceng231er2.tab3_1_1_1_5" id="hd_h_niceng231er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with High dose PPI</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All-cause mortality</td><td headers="hd_h_niceng231er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>2535</p>
|
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<p>(1 RCT)</p>
|
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</td><td headers="hd_h_niceng231er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>⨁⨁⨁◯</p>
|
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<p>Moderate<sup>a</sup></p>
|
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</td><td headers="hd_h_niceng231er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>RR 0.75</p>
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<p>(0.57 to 0.99)</p>
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</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">83 per 1,000</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>21 fewer per 1,000</p>
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<p>(36 fewer to 1 fewer)</p>
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</td></tr><tr><td headers="hd_h_niceng231er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cause-specific mortality</td><td headers="hd_h_niceng231er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>2535</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>⨁⨁◯◯</p>
|
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<p>Low<sup>a</sup></p>
|
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</td><td headers="hd_h_niceng231er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>RR 0.66</p>
|
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<p>(0.27 to 1.62)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9 per 1,000</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>3 fewer per 1,000</p>
|
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<p>(7 fewer to 6 more)</p>
|
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</td></tr><tr><td headers="hd_h_niceng231er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oesophageal Adenocarcinoma</td><td headers="hd_h_niceng231er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>2535</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>Low<sup>a</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.97</p>
|
|
<p>(0.63 to 1.49)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32 per 1,000</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>1 fewer per 1,000</p>
|
|
<p>(12 fewer to 16 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High-grade dysplasia</td><td headers="hd_h_niceng231er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>2535</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>Moderate<sup>a</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>RR 0.74</p>
|
|
<p>(0.51 to 1.09)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47 per 1,000</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>12 fewer per 1,000</p>
|
|
<p>(23 fewer to 4 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious adverse events</td><td headers="hd_h_niceng231er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>2535</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁⨁⨁</p>
|
|
<p>High</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.00</p>
|
|
<p>(0.87 to 1.13)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">265 per 1,000</td><td headers="hd_h_niceng231er2.tab3_1_1_1_5 hd_h_niceng231er2.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>0 fewer per 1,000</p>
|
|
<p>(34 fewer to 34 more)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng231er2.tab3_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs (default MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng231er2tab4"><div id="niceng231er2.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: Aspirin compared to no Aspirin for Barrett’s Oesophagus</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng231er2.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng231er2.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">
|
|
<p>№ of participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow-up</p>
|
|
</th><th id="hd_h_niceng231er2.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">
|
|
<p>Certainty of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng231er2.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th><th id="hd_h_niceng231er2.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng231er2.tab4_1_1_1_5" id="hd_h_niceng231er2.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with no Aspirin</th><th headers="hd_h_niceng231er2.tab4_1_1_1_5" id="hd_h_niceng231er2.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Aspirin</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">All-cause mortality</td><td headers="hd_h_niceng231er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2280</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>Moderate<sup>a</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.81</p>
|
|
<p>(0.60 to 1.10)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79 per 1,000</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>15 fewer per 1,000</p>
|
|
<p>(32 fewer to 8 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cause-specific mortality</td><td headers="hd_h_niceng231er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2280</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>Low<sup>a</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.00</p>
|
|
<p>(0.38 to 2.66)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 per 1,000</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>0 fewer per 1,000</p>
|
|
<p>(4 fewer to 12 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oesophageal Adenocarcino ma</td><td headers="hd_h_niceng231er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2280</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁◯◯</p>
|
|
<p>Low<sup>a</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.00</p>
|
|
<p>(0.63 to 1.59)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31 per 1,000</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>0 fewer per 1,000</p>
|
|
<p>(11 fewer to 18 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High-grade dysplasia</td><td headers="hd_h_niceng231er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2280</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>Moderate<sup>a</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.68</p>
|
|
<p>(0.45 to 1.02)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48 per 1,000</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>15 fewer per 1,000</p>
|
|
<p>(26 fewer to 1 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious adverse events</td><td headers="hd_h_niceng231er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>2280</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁⨁⨁◯</p>
|
|
<p>Moderate<sup>a</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 1.17</p>
|
|
<p>(1.02 to 1.35)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">238 per 1,000</td><td headers="hd_h_niceng231er2.tab4_1_1_1_5 hd_h_niceng231er2.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>40 more per 1,000</p>
|
|
<p>(5 more to 83 more)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng231er2.tab4_1"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs (default MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng231er2tab5"><div id="niceng231er2.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: Pantoprazole compared to Lansoprazole for Barrett’s Oesophagus</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng231er2.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng231er2.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">
|
|
<p>№ of participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow-up</p>
|
|
</th><th id="hd_h_niceng231er2.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">
|
|
<p>Certainty of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng231er2.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th><th id="hd_h_niceng231er2.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng231er2.tab5_1_1_1_5" id="hd_h_niceng231er2.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Lansoprazole</th><th headers="hd_h_niceng231er2.tab5_1_1_1_5" id="hd_h_niceng231er2.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Pantoprazole</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low-grade dysplasia</td><td headers="hd_h_niceng231er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.67</p>
|
|
<p>(0.04 to 10.32)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab5_1_1_1_5 hd_h_niceng231er2.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 per 1,000</td><td headers="hd_h_niceng231er2.tab5_1_1_1_5 hd_h_niceng231er2.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>9 fewer per 1,000</p>
|
|
<p>(27 fewer to 259 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High-grade dysplasia</td><td headers="hd_h_niceng231er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>90</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.67</p>
|
|
<p>(0.04 to 10.32)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab5_1_1_1_5 hd_h_niceng231er2.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 per 1,000</td><td headers="hd_h_niceng231er2.tab5_1_1_1_5 hd_h_niceng231er2.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>9 fewer per 1,000</p>
|
|
<p>(27 fewer to 259 more)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng231er2.tab5_1"><p class="no_margin">Downgraded by 1 increment as the evidence was at high risk of bias due to limited information regarding the methodology, analysis and participant characteristics</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng231er2.tab5_2"><p class="no_margin">Downgraded by 1 increment due to the study including a partially indirect population with a small number of people having dysplasia at baseline</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng231er2.tab5_3"><p class="no_margin">Downgraded by 2 increments as the confidence interval crossed both MIDs (default MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng231er2tab6"><div id="niceng231er2.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: Lansoprazole compared to Omeprazole for Barrett’s Oesophagus</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng231er2.tab6_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab6_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng231er2.tab6_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab6_1_1_1_2" style="text-align:left;vertical-align:bottom;">
|
|
<p>№ of participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow-up</p>
|
|
</th><th id="hd_h_niceng231er2.tab6_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab6_1_1_1_3" style="text-align:left;vertical-align:bottom;">
|
|
<p>Certainty of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng231er2.tab6_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab6_1_1_1_4" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th><th id="hd_h_niceng231er2.tab6_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng231er2.tab6_1_1_1_5" id="hd_h_niceng231er2.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Omeprazole</th><th headers="hd_h_niceng231er2.tab6_1_1_1_5" id="hd_h_niceng231er2.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Lansoprazole</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low-grade dysplasia</td><td headers="hd_h_niceng231er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>66</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.83</p>
|
|
<p>(0.05 to 12.77)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab6_1_1_1_5 hd_h_niceng231er2.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 per 1,000</td><td headers="hd_h_niceng231er2.tab6_1_1_1_5 hd_h_niceng231er2.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>6 fewer per 1,000</p>
|
|
<p>(32 fewer to 392 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High-grade dysplasia</td><td headers="hd_h_niceng231er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>66</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.83</p>
|
|
<p>(0.05 to 12.77)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab6_1_1_1_5 hd_h_niceng231er2.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 per 1,000</td><td headers="hd_h_niceng231er2.tab6_1_1_1_5 hd_h_niceng231er2.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>6 fewer per 1,000</p>
|
|
<p>(32 fewer to 392 more)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng231er2.tab6_1"><p class="no_margin">Downgraded by 1 increment as the evidence was at high risk of bias due to limited information regarding the methodology, analysis and participant characteristics</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng231er2.tab6_2"><p class="no_margin">Downgraded by 1 increment due to the study including a partially indirect population with a small number of people having dysplasia at baseline</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng231er2.tab6_3"><p class="no_margin">Downgraded by 2 increments as the confidence interval crossed both MIDs (default MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng231er2tab7"><div id="niceng231er2.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: Pantoprazole compared to Omeprazole for Barrett’s Oesophagus</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng231er2.tab7_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab7_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng231er2.tab7_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab7_1_1_1_2" style="text-align:left;vertical-align:bottom;">
|
|
<p>№ of participants</p>
|
|
<p>(studies)</p>
|
|
<p>Follow-up</p>
|
|
</th><th id="hd_h_niceng231er2.tab7_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab7_1_1_1_3" style="text-align:left;vertical-align:bottom;">
|
|
<p>Certainty of the evidence</p>
|
|
<p>(GRADE)</p>
|
|
</th><th id="hd_h_niceng231er2.tab7_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng231er2.tab7_1_1_1_4" style="text-align:left;vertical-align:bottom;">
|
|
<p>Relative effect</p>
|
|
<p>(95% CI)</p>
|
|
</th><th id="hd_h_niceng231er2.tab7_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng231er2.tab7_1_1_1_5" id="hd_h_niceng231er2.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Omeprazole</th><th headers="hd_h_niceng231er2.tab7_1_1_1_5" id="hd_h_niceng231er2.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Pantoprazole</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Low-grade dysplasia</td><td headers="hd_h_niceng231er2.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>84</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.56</p>
|
|
<p>(0.04 to 8.57)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab7_1_1_1_5 hd_h_niceng231er2.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 per 1,000</td><td headers="hd_h_niceng231er2.tab7_1_1_1_5 hd_h_niceng231er2.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>15 fewer per 1,000</p>
|
|
<p>(32 fewer to 252 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High-grade dysplasia</td><td headers="hd_h_niceng231er2.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>84</p>
|
|
<p>(1 RCT)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>⨁◯◯◯</p>
|
|
<p>Very low<sup>a</sup><sup>,</sup><sup>b</sup><sup>,</sup><sup>c</sup></p>
|
|
</td><td headers="hd_h_niceng231er2.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RR 0.56</p>
|
|
<p>(0.04 to 8.57)</p>
|
|
</td><td headers="hd_h_niceng231er2.tab7_1_1_1_5 hd_h_niceng231er2.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 per 1,000</td><td headers="hd_h_niceng231er2.tab7_1_1_1_5 hd_h_niceng231er2.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>15 fewer per 1,000</p>
|
|
<p>(32 fewer to 252 more)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng231er2.tab7_1"><p class="no_margin">Downgraded by 1 increment as the evidence was at high risk of bias due to limited information regarding the methodology, analysis and participant characteristics</p></div></dd></dl><dl class="bkr_refwrap"><dt>b</dt><dd><div id="niceng231er2.tab7_2"><p class="no_margin">Downgraded by 1 increment due to the study including a partially indirect population with a small number of people having dysplasia at baseline</p></div></dd></dl><dl class="bkr_refwrap"><dt>c</dt><dd><div id="niceng231er2.tab7_3"><p class="no_margin">Downgraded by 2 increments as the confidence interval crossed both MIDs (default MIDs for dichotomous outcomes: 0.8 and 1.25)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng231er2tab8"><div id="niceng231er2.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Unit cost of drugs</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.tab8_lrgtbl__"><table><thead><tr><th id="hd_h_niceng231er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resource</th><th id="hd_h_niceng231er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit costs</th><th id="hd_h_niceng231er2.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Antacids</td><td headers="hd_h_niceng231er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£30.75</td><td headers="hd_h_niceng231er2.tab8_1_1_1_3" rowspan="5" colspan="1" style="text-align:left;vertical-align:middle;">Prescription Cost Analysis 2020/21</td></tr><tr><td headers="hd_h_niceng231er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aspirin</td><td headers="hd_h_niceng231er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.20</td></tr><tr><td headers="hd_h_niceng231er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">H2 receptor antagonists</td><td headers="hd_h_niceng231er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£15.62</td></tr><tr><td headers="hd_h_niceng231er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Proton pump inhibitors</td><td headers="hd_h_niceng231er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2.31</td></tr><tr><td headers="hd_h_niceng231er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statins</td><td headers="hd_h_niceng231er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.82</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng231er2apphtab1"><div id="niceng231er2.apph.tab1" class="table"><h3><span class="label">Table 16</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK595771/table/niceng231er2.apph.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng231er2.apph.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
(2020) Erratum: correction: argon plasma coagulation for Barrett’s esophagus with low-grade dysplasia: a randomized trial with long-term follow-up on the impact of power setting and proton pump inhibitor dose (Endoscopy (2020)). Endoscopy [<a href="https://pubmed.ncbi.nlm.nih.gov/33003211" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33003211</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Full text paper not available</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
(2018) Erratum: esomeprazole and aspirin in Barrett’s oesophagus (AspECT): a randomised factorial trial (The Lancet (2018) 392(10145) (400-408), (S0140673618313886) (10.1016/S0140-6736(18)31388-6)). Lancet
|
|
392(10164): 2552 [<a href="/pmc/articles/PMC6083438/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6083438</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30057104" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30057104</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Duplicate reference</p>
|
|
<p>
|
|
<i>Summary of paper included in the review</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Attwood, S. E., Lundell, L., Hatlebakk, J. G.
|
|
et al. (2008) Medical or surgical management of GERD patients with Barrett’s esophagus: the LOTUS trial 3-year experience. Journal of Gastrointestinal Surgery
|
|
12(10): 1646–54; discussion 1654 [<a href="https://pubmed.ncbi.nlm.nih.gov/18709511" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18709511</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>Comparing pharmacological treatment with anti-reflux surgery</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Caldwell, M. T. P., Byrne, P. J., Walsh, T. N.
|
|
et al. (1996) A randomized trial on the effect of acid suppression on regression of Barrett’s oesophagus. Gastroenterology
|
|
110(4): a074
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Full text paper not available</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chen, Y., Sun, C., Wu, Y.
|
|
et al. (2021) Do proton pump inhibitors prevent Barrett’s esophagus progression to high-grade dysplasia and esophageal adenocarcinoma? An updated meta-analysis. Journal of Cancer Research & Clinical Oncology
|
|
147(9): 2681–2691 [<a href="https://pubmed.ncbi.nlm.nih.gov/33575855" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33575855</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review of non-randomized studies</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
de Bortoli, N., Martinucci, I., Piaggi, P.
|
|
et al. (2011) Randomised clinical trial: twice daily esomeprazole 40 mg vs. pantoprazole 40 mg in Barrett’s oesophagus for 1 year. Alimentary Pharmacology & Therapeutics
|
|
33(9): 1019–27 [<a href="https://pubmed.ncbi.nlm.nih.gov/21385192" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21385192</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>Assessing scoring of Ki67, COX-2 expression, apoptotic staining and oesophageal pH-metry</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Eslami, L. and Nasseri-Moghaddam, S. (2013) Meta-analyses: does long-term PPI use increase the risk of gastric premalignant lesions?. Archives of Iranian Medicine
|
|
16(8): 449–58 [<a href="https://pubmed.ncbi.nlm.nih.gov/23906249" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23906249</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to this review protocol</p>
|
|
<p>Assessing the incidence of (pre)malignant gastric lesions</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Falk, G. W., Buttar, N. S., Foster, N. R.
|
|
et al. (2012) A combination of esomeprazole and aspirin reduces tissue concentrations of prostaglandin E(2) in patients with Barrett’s esophagus. Gastroenterology
|
|
143(4): 917–26.e1 [<a href="/pmc/articles/PMC3458136/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3458136</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22796132" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22796132</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>Assessing PGE2 concentrations in Barrett’s mucosa</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Faybush, E. M. and Sampliner, R. E. (2005) Randomized trials in the treatment of Barrett’s esophagus. Diseases of the Esophagus
|
|
18(5): 291–7 [<a href="https://pubmed.ncbi.nlm.nih.gov/16197527" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16197527</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Systematic review including interventions not relevant to the protocol</p>
|
|
<p>Comparing different therapeutic modalities e.g. Anti-reflux surgery, argon plasma coagulation, photodynamic therapy</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Frazzoni, M., Manno, M., De Micheli, E.
|
|
et al. (2007) Efficacy in intra-oesophageal acid suppression may decrease after 2-year continuous treatment with proton pump inhibitors. Digestive and liver disease
|
|
39(5): 415–421 [<a href="https://pubmed.ncbi.nlm.nih.gov/17379591" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17379591</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>Assessing oesophageal acid exposure</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hoffman, A., Kiesslich, R., Vieth, M.
|
|
et al. (2007) Influence of acid suppression with Esomeprazole on the length and area of Barrett’s oesophagus without intra-epithelial neoplasia - a prospective, randomised studye. Zeitschrift fur gastroenterologie
|
|
45(8): 742
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Husain, N. S. and El-Serag, H. B. (2018) Chemoprevention of Barrett’s oesophagus: a step closer with PPIs and aspirin. Nature Reviews Clinical Oncology
|
|
15(12): 728–730 [<a href="https://pubmed.ncbi.nlm.nih.gov/30237519" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30237519</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kantor, E. D., Onstad, L., Blount, P. L.
|
|
et al. (2012) Use of statin medications and risk of esophageal adenocarcinoma in persons with Barrett’s esophagus. Cancer Epidemiology, Biomarkers & Prevention
|
|
21(3): 456–61 [<a href="/pmc/articles/PMC3297725/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3297725</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22241250" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22241250</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>Prospective cohort study</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Klaus, A. and Hinder, R. A. (2000) Medical therapy versus antireflux surgery in Barrett’s esophagus: what is the best therapeutic approach?. Digestive Diseases
|
|
18(4): 224–31 [<a href="https://pubmed.ncbi.nlm.nih.gov/11356994" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11356994</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lanas, A., Ortego, J., Sopeña, F.
|
|
et al. (2004) Effects of prolonged treatment with an inhibitor of COX-2 in cell proliferation in patients with Barrett’s esophagus. Preliminary results of a multicenter, randomized, controlled trial. Gastroenterologia y hepatologia
|
|
27(3): 186–187
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Li, H.; Zhang, Z. Y.; Wang, T. G. (1999) Function of omeprazole in including reversibility of Barrett’s esophagus mucosa. Chinese journal of digestion
|
|
19(4): 279–280
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Full text paper not available</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Li, L., Cao, Z., Zhang, C.
|
|
et al. (2021) Risk of esophageal adenocarcinoma in patients with Barrett’s esophagus using proton pump inhibitors: A systematic review with meta-analysis and sequential trial analysis. Translational Cancer Research
|
|
10(4): 1620–1627 [<a href="/pmc/articles/PMC8798809/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8798809</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35116488" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35116488</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>Review of non-randomized studies</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Li, Y. M., Li, L., Yu, C. H.
|
|
et al. (2008) A systematic review and meta-analysis of the treatment for Barrett’s esophagus. Digestive Diseases & Sciences
|
|
53(11): 2837–46 [<a href="https://pubmed.ncbi.nlm.nih.gov/18427992" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18427992</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Systematic review not relevant to the protocol</p>
|
|
<p>Includes studies with interventions comparing different therapeutic modalities e.g.: Anti-reflux surgery, argon plasma coagulation, photodynamic therapy</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Manifold, D. K., Marshall, R. E., Anggiansah, A.
|
|
et al. (2000) Effect of omeprazole on antral duodenogastric reflux in Barrett oesophagus. Scandinavian Journal of Gastroenterology
|
|
35(8): 796–801 [<a href="https://pubmed.ncbi.nlm.nih.gov/10994616" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10994616</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>Assessing oesophageal acid exposure, gastric alkaline shift and duodeno-gastric reflux</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ortiz, A., Martinez De Haro, L. F., Parrilla, P.
|
|
et al. (1996) Conservative treatment versus antireflux surgery in Barrett’s oesophagus: Long-term results of a prospective study. British Journal of Surgery
|
|
83(2): 274–278 [<a href="https://pubmed.ncbi.nlm.nih.gov/8689188" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8689188</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>Comparing pharmacological treatment with anti-reflux surgery</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Parrilla, P., Martinez de Haro, L. F., Ortiz, A.
|
|
et al. (2003) Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Annals of Surgery
|
|
237(3): 291–8 [<a href="/pmc/articles/PMC1514316/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1514316</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12616111" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12616111</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>Comparing pharmacological treatment with anti-reflux surgery</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Peters, F. T. M., Ganesh, S., Kuipers, E. J.
|
|
et al. (1997) Regression of Barrett’s oesophagus during omeprazole: a randomized double-blinded study. European journal of gastroenterology & hepatology
|
|
9(suppl12): a39
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Peters, F. T., Ganesh, S., Kuipers, E. J.
|
|
et al. (1999) Endoscopic regression of Barrett’s oesophagus during omeprazole treatment; a randomised double blind study. Gut
|
|
45(4): 489–94 [<a href="/pmc/articles/PMC1727665/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1727665</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10486353" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10486353</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>Assessing regression of Barrett’s oesophagus</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sampliner, R. E. (1994) Effect of up to 3 years of high-dose lansoprazole on Barrett’s esophagus. American Journal of Gastroenterology
|
|
89(10): 1844–8 [<a href="https://pubmed.ncbi.nlm.nih.gov/7942680" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7942680</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study design not relevant to this review protocol – Non-randomized study</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Singh, S., Singh, A. G., Singh, P. P.
|
|
et al. (2013) Statins are associated with reduced risk of esophageal cancer, particularly in patients with Barrett’s esophagus: a systematic review and meta-analysis. Clinical Gastroenterology & Hepatology
|
|
11(6): 620–9 [<a href="/pmc/articles/PMC3660516/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3660516</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23357487" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23357487</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review not relevant to the protocol; including on-randomized studies included</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sontag, S. J., Schnell, T. G., Chejfec, G.
|
|
et al. (1997) Lansoprazole heals erosive reflux oesophagitis in patients with Barrett’s oesophagus. Alimentary Pharmacology & Therapeutics
|
|
11(1): 147–56 [<a href="https://pubmed.ncbi.nlm.nih.gov/9042987" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9042987</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>- Assessing healing rate</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sopeña, F., Fernández, A., Ortego, J.
|
|
et al. (2006) Final results of a 6-month randomized controlled trial on the effects of rofecoxib, a selective inhibitor of COX-2 in patients with Barrett’s esophagus. Gastroenterologia y hepatologia
|
|
29: 156
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Spechler, S. J.; Barker, P. N.; Silberg, D. G. (2009) Clinical trial: intragastric acid control in patients who have Barrett’s oesophagus-comparison of once- and twice-daily regimens of esomeprazole and lansoprazole. Alimentary Pharmacology & Therapeutics
|
|
30(2): 138–45 [<a href="https://pubmed.ncbi.nlm.nih.gov/19438416" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19438416</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>Assessing intragastric pH control</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Spechler, S. J., Sharma, P., Traxler, B.
|
|
et al. (2006) Gastric and esophageal pH in patients with Barrett’s esophagus treated with three esomeprazole dosages: a randomized, double-blind, crossover trial. American Journal of Gastroenterology
|
|
101(9): 1964–71 [<a href="https://pubmed.ncbi.nlm.nih.gov/16848802" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16848802</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Outcome not relevant to protocol</p>
|
|
<p>Assessing 24-h, intragastric and distal intra-oesophageal pH</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Triadafilopoulos, G. (2000) Proton pump inhibitors for Barrett’s oesophagus. Gut
|
|
46(2): 144–146 [<a href="/pmc/articles/PMC1727807/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1727807</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10644301" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10644301</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Full text paper not available</p>
|
|
<p>Editorial</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wassenaar, E. B. and Oelschlager, B. K. (2010) Effect of medical and surgical treatment of Barrett’s metaplasia. World Journal of Gastroenterology
|
|
16(30): 3773–9 [<a href="/pmc/articles/PMC2921088/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2921088</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20698039" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20698039</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Weinstein, W. M., Lieberman, D., Lewin, D. N.
|
|
et al. (1996) Omeprazole-induced regression of Barrett’s oesophagus: a 2 year randomized controlled double blind trial. Gastroenterology
|
|
110(4): a294
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Full text paper not available</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wilson, H., Mocanu, V., Sun, W.
|
|
et al. (2021) Fundoplication is superior to medical therapy for Barrett’s esophagus disease regression and progression: a systematic review and meta-analysis. Surgical Endoscopy
|
|
18: 18 [<a href="https://pubmed.ncbi.nlm.nih.gov/34008109" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34008109</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Comparator in study does not match that specified in this review protocol</p>
|
|
<p>Comparing pharmacological treatment with anti-reflux surgery</p>
|
|
</td></tr><tr><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Zhang, J.; Wu, H.; Wang, R. (2021) Effect of nonsteroidal anti-inflammatory drugs on Barrett’s esophagus risk: a systematic review and meta-analysis. Clinics & Research in Hepatology & Gastroenterology
|
|
45(3): 101552 [<a href="https://pubmed.ncbi.nlm.nih.gov/33268293" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33268293</span></a>]
|
|
</td><td headers="hd_h_niceng231er2.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Systematic review used as source of primary studies</p>
|
|
<p>
|
|
<i>review of non-randomised studies</i>
|
|
</p>
|
|
</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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