NSAIDs, statins, PPIs for risk of adenocarcinoma in Barrett's esophagus

Q: Aspirin and NSAIDs may have a protective effect on Barrett's esophagus for the development of esophageal carcinoma?

A) True

B) False

Answer: A

Although it may be counterintuitive to think that aspirin (ASA) or nonsteroidal anti-inflammatory drugs (NSAIDs) have a protective effect for esophageal carcinoma in patients with Barrett's esophagus, studies have shown some weak evidence for it. In other words, they can be labeled chemopreventive in Barrett's esophagus. Of both, aspirin appears to contribute more in delaying the progression of Barrett's esophagus. This effect seems enhanced and synergistic when combined with Proton-Pump-Inhibitors (PPIs) and statin.

This effect appears to be transmitted via the inhibition of cyclooxygenase-2 suppresses growth and induces apoptosis.

#GI

#oncology

References:

1. Nguyen DM, El-Serag HB, Henderson L, et al. Medication usage and the risk of neoplasia in patients with Barrett's esophagus. Clin Gastroenterol Hepatol 2009; 7:1299.

2. Corley DA, Kerlikowske K, Verma R, Buffler P. Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 2003; 124:47.

3. Souza RF, Shewmake K, Beer DG, et al. Selective inhibition of cyclooxygenase-2 suppresses growth and induces apoptosis in human esophageal adenocarcinoma cells. Cancer Res 2000; 60:5767.

4. Nguyen DM, Richardson P, El-Serag HB. Medications (NSAIDs, statins, proton pump inhibitors) and the risk of esophageal adenocarcinoma in patients with Barrett's esophagus. Gastroenterology 2010; 138:2260.