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Nonsteroidal anti-inflammatory drugs and the esophageal inflammation-metaplasia-adenocarcinoma sequence

Lesley A Anderson1, Brian T Johnston, R G Peter Watson

  • 1Centre for Clinical and Population Sciences, Queen's University, Belfast, Northern Ireland. l.anderson@qub.ac.uk

Cancer Research
|May 3, 2006
PubMed

Insights

Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, may reduce the risk of Barrett's esophagus and esophageal adenocarcinoma. These findings suggest NSAIDs might act early in the esophageal cancer development sequence.

Area of Science:

  • Gastroenterology
  • Oncology
  • Pharmacology

Background:

  • Observational studies suggest nonsteroidal anti-inflammatory drugs (NSAIDs) may lower esophageal adenocarcinoma risk.
  • The specific stage at which NSAIDs might act within the inflammation-metaplasia-adenocarcinoma sequence is unclear.

Purpose of the Study:

  • To investigate the association between NSAID use and the risk of reflux esophagitis, Barrett's esophagus, and esophageal adenocarcinoma.
  • To determine if NSAIDs influence early or late stages of esophageal carcinogenesis.

Main Methods:

  • An all-Ireland case-control study involving patients with esophageal adenocarcinoma, Barrett's esophagus, reflux esophagitis, and population controls.
  • Data collected on NSAID (including aspirin) use at least one year prior to interview.
  • Multiple logistic regression analysis used to estimate associations.

Main Results:

  • NSAID and aspirin use were associated with a reduced risk of Barrett's esophagus (OR 0.40-0.53) and esophageal adenocarcinoma (OR 0.57-0.58).
  • Patients with Barrett's esophagus and esophageal adenocarcinoma were less likely to report NSAID use compared to controls.
  • Potential for selection or recall bias was acknowledged.

Conclusions:

  • NSAIDs, particularly aspirin, may have a protective effect against Barrett's esophagus and esophageal adenocarcinoma.
  • If a protective effect exists, NSAIDs likely act early in the esophageal inflammation-metaplasia-adenocarcinoma sequence.
  • Further research is needed to confirm these findings and elucidate the mechanism of action.

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