Should you be prescribing your Barrett’s esophagus patients aspirin to prevent esophageal adenocarcinomas?
James Franklin, BMBS, and Janusz Jankowski, MD, PhD, make the case for the potential long-term chemoprevention role aspirin could play in Barrett’s esophagus patients due to:
- The role of aspirin in chemoprevention of other gastrointestinal cancers especially colon.
- Epidemiology studies showing aspirin preventing upper gastrointestinal cancer.
- Aspirin preventing inflammation and surrogate markers of risk in Barrett’s esophagus.
- Aspirin preventing deaths and high-grade dysplasia in Barrett’s.
- Safety of low dose aspirin for gastrointestinal bleeding especially when given with PPIs.
Prasad G. Iyer, MD, MSc, AGAF, says aspirin cannot be recommended for chemoprevention in all Barrett’s esophagus patients at this time. Specifically:
- Patients with Barrett’s esophagus without dysplasia have low risk of progression and COX inhibition with aspirin to prevent progression is theoretically intriguing.
- Retrospective studies seem to support the potential of EAC chemoprevention with aspirin use.
- However, evidence of the efficacy of COX inhibition in prospective studies is weak. The large AspECT trial did not show evidence of reduction in the incidence of EAC or HGD with the use of 300 mg/day over a mean follow up of almost nine years.
- The risk of serious bleeding (gastrointestinal and cerebrovascular) is roughly doubled in patients on low dose aspiring in large community based primary prevention RCTs.
Review this debate and other expert discourse in AGA Perspectives.
AGA Perspectives will soon be part of GI & Hep News. Same great content, new format. Stay tuned for more information.