Aspirin Use is Associated with Lower Risk of Barrett's Esophagus in Women

Abstract

OBJECTIVES: Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma. Data examining the association of aspirin with the onset of BE, particularly for women, are scant and conflicting. METHODS: We leveraged data from 121,700 women enrolled in the Nurses' Health Study, a large prospective cohort study, who biennially provided detailed information regarding endoscopy and use of aspirin. We used unconditional logistic regression to obtain multivariable (MV)-adjusted odds ratios (ORs) and 95% confidence intervals (CI) to estimate the risk of BE in regular aspirin users (≥2 times/week) compared to non-regular users. RESULTS: Among 27,881 women who had undergone upper GI endoscopy, we documented 667 BE cases over 18 years of followup. Compared to non-regular users, women who regularly used aspirin had a MV-adjusted OR for BE of 0.85 (95%CI: 0.72, 0.99). The corresponding OR was 0.73 (95%CI: 0.56, 0.96) for BE at least 1 cm long. Compared with women who did not use any aspirin, the MV-adjusted OR for any BE was 0.91 (95% CI, 0.69, 1.20) for women taking 0.5-1.5 tablets/week; 0.92 (95%CI 0.76, 1.11) for 2-5 tablets/week; and 0.71 (95%CI 0.55, 0.92) for ≥ 6 tablets/week (p-trend = 0.01). Compared with non-regular users, the MV-adjusted OR for BE risk was 0.90 (95%CI 0.67, 1.20) for women who regularly used aspirin for 1-5 years, 0.84 (95%CI 0.65, 1.09) for 6-10 years, and 0.81 (95%CI 0.67, 0.97) for 410 years (p-trend = 0.03). CONCLUSION: Regular aspirin use was associated with a reduction in the risk of Barrett's esophagus in women. The reduction in risk appeared related to higher dose and longer duration of use.

Esomeprazole and aspirin in Barrett's oesophagus (AspECT): a randomised factorial trial

“… 14 Esomeprazole is the most commonly used PPI in the USA, and allows the healing of oesophagitis without promoting clonal expansion of Barrett's oesophagus. 15 Observational data suggest that aspirin use is associated with reduced risk of oesophageal adenocarcinoma, 16 , 17 , 18 , 19 but this is not a universal finding. 20 Finally, although Barrett's oesophagus is a major risk factor for oesophageal adenocarcinoma, only a minority of patients with Barrett's oesophagus die from oesophageal adenocarcinoma; most die from cardiovascular disease or chest infections.…”

Gastroesophageal reflux disease and Barrett’s oesophagus: an overview of evidence-based guidelines

“…However, data from this randomized controlled trial supports previous observational data which suggested a chemopreventive link between EAC aspirin and PPI, and metanalysis data from cardiovascular studies with aspirin which showed lower EAC rates (though these were not primary end points). 96,97 The way in which the AspECT data is interpreted may be similar to the other recommendations discussed in this paper -targeting of high -risk groups to streamline interventions is likely to be the future.…”

Chemoprevention in Barrett’s esophagus and esophageal adenocarcinoma

“…In the Nurses’ Health study, 667 patients developed BE among 27,881 women over 18 years of follow-up. 28 Using multivariate analysis, women who regularly used aspirin had a lower risk of BE (OR = 0.85; CI = 0.72–0.99). Similar results were demonstrated in a case-control study where patients on regular aspirin had lower risk of BE especially among persons with GERD symptoms.…”