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

Abstract

Observational studies suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the risk of esophageal adenocarcinoma, but it is not known at what stage they may act in the esophageal inflammation-metaplasia-adenocarcinoma sequence. In an all-Ireland case-control study, we investigated the relationship between the use of NSAIDs and risk of reflux esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. Patients with esophageal adenocarcinoma, long-segment Barrett's esophagus and population controls were recruited from throughout Ireland. Esophagitis patients were recruited from Northern Ireland only. Data were collected on known and potential risk factors for esophageal adenocarcinoma and on the use of NSAIDs, including aspirin, at least 1 year before interview. Associations between use of NSAIDs and the stages of the esophageal inflammation-metaplasia-adenocarcinoma sequence were estimated by multiple logistic regression. In total, 230 reflux esophagitis, 224 Barrett's esophagus, and 227 esophageal adenocarcinoma and 260 population controls were recruited. Use of aspirin and NSAIDs was associated with a reduced risk of Barrett's esophagus [odds ratio [OR; 95% confidence interval (95% CI)], 0.53 (0.31-0.90) and 0.40 (0.19-0.81), respectively] and esophageal adenocarcinoma [OR (95% CI), 0.57 (0.36-0.93) and 0.58 (0.31-1.08), respectively]. Barrett's esophagus and esophageal adenocarcinoma patients were less likely than controls to have used NSAIDs. Selection or recall bias may explain these results and the results of previous observational studies indicating a protective effect of NSAIDs against esophageal adenocarcinoma. If NSAIDs have a true protective effect on the esophageal inflammation-metaplasia-adenocarcinoma sequence, they may act early in the sequence.

• Authors: Lesley A Anderson, Brian T Johnston, R G Peter Watson, Seamus J Murphy, Heather R Ferguson, Harry Comber, Jim McGuigan, John V Reynolds, Liam J Murray
• Journal: Cancer research (Cancer Res) Vol. 66 Issue 9 Pg. 4975-82 (May 01 2006) ISSN: 0008-5472 [Print] United States
• PMID: 16651456 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Acetaminophen
• Aspirin

Topics

• Acetaminophen (administration & dosage)
• Adenocarcinoma (drug therapy, pathology, prevention & control)
• Aged
• Aged, 80 and over
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage)
• Aspirin (administration & dosage)
• Barrett Esophagus (drug therapy, pathology, prevention & control)
• Case-Control Studies
• Esophageal Neoplasms (drug therapy, pathology, prevention & control)
• Esophagitis, Peptic (drug therapy, pathology, prevention & control)
• Esophagus (drug effects, pathology)
• Female
• Humans
• Male
• Metaplasia
• Middle Aged