Non-steroidal anti-inflammatory drugs may prevent the development of oesophageal adenocarcinoma in patients with Barrett's oesophagus

Non-steroidal anti-inflammatory drugs (NSAID) such as aspirin might be effective in preventing the development of oesophageal adenocarcinoma in patients with Barrett's oesophagus, according to US researchers reporting online in The Lancet Oncology.

"An inexpensive, widely available, and fairly safe means of preventing neoplastic progression in people at high risk of oesophageal cancer would have substantial benefits in terms of public health and economics", says lead author Dr Thomas Vaughan.

Barrett’s oesophagus is a metaplastic disorder that develops in about 10% of people with chronic gastro-oesophageal reflux disease. Every year about 0.5%-1% of patients with Barrett’s oesophagus develop oesophageal adenocarcinoma. Although the incidence of oesophageal adenocarcinoma is increasing, the mechanisms underlying its development are not yet fully understood. NSAID use is thought to prevent the development of colorectal cancer and adenomatous polyps mainly through inhibition of cyclo-oxygenase, an enzyme with tumour-promoting properties. Human and animal studies have suggested these drugs might have a role in preventing neoplastic progression in oesophageal adenocarcinoma.

Vaughan and colleagues therefore investigated prospectively the relation between the duration, frequency, and recency of NSAID use and risk of oesophageal adenocarcinoma in 350 people with Barrett’s oesophagus. Median follow-up was 65.5months (range 3.1-106.9).

Current NSAID users had a significantly lower risk than never users (Hazard ratio [HR] 0.32 [95% CI 0.14-0.76]). Former users also had a lower risk but this was non-significant. No relation with risk for duration and frequency of drug use was found. The associations were strengthened when NSAID use during follow up was taken into account (HR 0.20 [0.10-0.41]) for current users compared with never users. 5-year cumulative incidence of oesophageal adenocarcinoma was 14.3% (9.3-21.6) for never users, 9.7% (4.5-20.5) for former users and 6.6% (3.1-13.6) for current users.

Dr Vaughan states "NSAID use might be an effective chemopreventive strategy, reducing the risk of neoplastic progression in Barrett’s oesophagus".