Aspirin Protects Against Barrett's Esophagus in a Multivariate Logistic Regression Analysis

Abstract

Background & Aims Better criteria are needed to identify patients that should be screened for Barrett’s esophagus (BE), to reduce over-testing and improve the cost effectiveness. There is evidence that chemopreventive agents such as non-steroidal anti-inflammatory drugs—particularly aspirin—reduce the risk of esophageal adenocarcinoma (EAC), but little is known about their effects on BE. We analyzed characteristics of patients with BE for factors that might be used in screening and management. Methods In this case-controlled study, we identified 434 patients with BE diagnosed at the first endoscopy (incident cases) at a single institution (1997–2010). BE cases were matched with controls on the basis of indication for endoscopy, year of endoscopy, and endoscopist. Risk factors analyzed included age, gender, BMI, medical and social history, and medications. We performed a multivariate logistic regression analysis to identify clinical risk factors for BE. Results In a multivariate regression model, men had a greater risk for developing BE (odds ratio [OR]=3.2; 95% confidence interval [CI], 2.3–4.4), whereas current aspirin users had a lower risk than non-users (OR=0.56; 95% CI, 0.39–0.80). A subset analysis, limited to patients who had endoscopies for symptoms of gastroesophageal reflux disease, yielded similar findings. No interactions were found between aspirin use and smoking, or use of acid suppressive medications. Conclusions In a case-controlled study of 434 patients with BE, current aspirin use appeared to reduce the risk of BE; previous studies associated aspirin use with a reduced risk of EAC.. Although efforts were made to minimize biases in our analysis, the possibility of residual confounding remains.

The role of obesity in oesophageal cancer development

“…A considerable amount of experimental data show that COX inhibitors, such as aspirin, reduce malignant behaviour such as proliferation and also induce apoptosis in OAC and non-neoplastic Barrett's cell lines, and nonspecific COX and COX-2 selective inhibitors block the effects of leptin in cell-line models [Ogunwobi and Beales, 2008b;Fang et al 2011;Beales and Ogunwobi, 2010]. Although more definitive conclusions on the preventative effects of aspirin may have to wait until the AspECT trial has reported [Das et al 2009], in observational studies and meta-analyses aspirin use has been reported to be associated with a reduced incidence of both BO and OAC [Omer et al 2012;Beales et al 2013]. Similarly, statins exert potent anticancer effects in OAC cell-line models by inhibiting small signalling G-protein prenylation and limiting procarcinogenic signalling from growth factor receptors [Ogunwobi and Beales, 2008c].…”

Esophageal COX-2 Expression Is Increased in Barrett’s Esophagus, Obesity, and Smoking

“…A case-control study from Ireland demonstrated NSAIDs to have a protective effect on the development of BE [32], and another case-control study from the USA found that the use of ASA appeared to reduce the risk of BE [34]. On the other hand, a casecontrol study from Australia found no significant association between NSAID use and BE [33].…”

“…Studies investigating non-selective COX inhibitors and NSAIDs for BE chemoprevention yielded conflicting results [32][33][34][35]. A case-control study from Ireland demonstrated NSAIDs to have a protective effect on the development of BE [32], and another case-control study from the USA found that the use of ASA appeared to reduce the risk of BE [34].…”

Reduced Risk of Barrett’s Esophagus in Statin Users: Case–Control Study and Meta-Analysis

“…One further study has attempted to examine the effects of the use of statins on the incidence of Barrett's esophagus. Omer et al reported that statin use was associated with a reduced rate of new diagnoses of Barrett's esophagus in the initial univariate analysis (OR 0.72 (95% CI 0.52 -0.98)) but the statistical significance of this finding was not confirmed in the multivariate analysis (aOR 0.79 (95% CI 0.54 -1.2) (22). Inaccuracies may be inherent in this study due to the purely retrospective nature of the data collection, lack of data on initiation of, or duration of statin use, relying on tertiary care centre endoscopy controls and the lack of matching in between cases and controls (there were significantly more females in the control group).…”