Aspirin and PPIs Might Prevent Cancer in Barrett Esophagus

In the largest randomized U.S. trial to date, a combination regimen reduced levels of a biomarker for increased production of the COX-2 enzyme, which is implicated in carcinogenesis.

Preclinical data suggest that nonsteroidal anti-inflammatory drugs (NSAIDs), particularly aspirin, may protect against the development of esophageal adenocarcinoma (EAC) by inhibiting the cyclooxygenase 1 and 2 (COX-1 and COX-2) enzymes, which regulate prostaglandin E₂ (PGE₂) production. A proposed mechanism for Barrett esophagus (BE) carcinogenesis is induced up-regulation of COX-2 (with high levels of PGE₂ production) from acid, bile salt, or both. If this biological premise is correct, treatment with a proton-pump inhibitor (PPI) combined with aspirin might be chemopreventive.

To investigate this possibility, researchers randomized 122 patients with histologically confirmed BE from multiple centers to receive esomeprazole (40 mg twice dai…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors