Medications (NSAIDs, statins, proton pump inhibitors) and the risk of esophageal adenocarcinoma in patients with...

Area of Science:

• Gastroenterology
• Oncology
• Pharmacology

Background:

• Limited evidence suggests proton pump inhibitors (PPI), nonsteroidal anti-inflammatory drugs (NSAID)/aspirin, and statins may be linked to lower esophageal neoplasia risk.
• The specific impact of these medications on esophageal adenocarcinoma (EAC) risk in patients with Barrett's esophagus (BE) remains unclear.

Purpose of the Study:

• To investigate the association between PPI, NSAID/aspirin, and statin use and the risk of developing esophageal adenocarcinoma (EAC) in patients diagnosed with Barrett's esophagus (BE).

Main Methods:

• A nested case-control study was conducted using national Department of Veterans' Affairs computerized databases.
• Patients with BE were identified, and incident EAC cases were matched to controls without EAC.
• Prescription data for PPI, NSAIDs/aspirin, and statins filled between BE diagnosis and EAC diagnosis were analyzed using conditional logistic regression.

Main Results:

• In a cohort of 11,823 BE patients, 116 EAC cases and 696 controls were analyzed. PPI use was nearly universal (95% vs 94%).
• NSAID/aspirin prescriptions were associated with a reduced EAC risk (aIDR, 0.64; 95% CI, 0.42-0.97).
• Statin prescriptions also showed a reduced EAC risk (aIDR, 0.55; 95% CI, 0.36-0.86), with greater risk reduction observed with longer duration of use, though uncontrolled confounding is a concern.

Conclusions:

• This observational study suggests that NSAID/aspirin and statin therapy may be associated with a reduced risk of esophageal adenocarcinoma in patients with Barrett's esophagus.
• The findings indicate a potential protective effect of these medications, but further research is needed to confirm causality and address confounding factors.