Cyclooxygenase inhibitors use is associated with reduced risk of esophageal adenocarcinoma in patients with Barrett’s esophagus: a meta-analysis

Zhang, Shuangjie; Zhang, X.; Ding, Xiwei; Yang, Ruike; Huang, Shenglan; Kastelein, Florine; Bruno, Marco J.; Yu, Xiaofang; Zhou, Detang; Zou, Xiaoping

doi:10.1038/bjc.2014.127

Cited by 67 publications

(43 citation statements)

References 48 publications

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“…No signifi cant eff ect was shown for H 2 RA usage in two studies ( 57 ). In another meta-analysis of 9 observational studies of 5,446 participants (605 with HGD or EAC), usage of cyclooxygenase inhibitors, aspirin, and nonaspirin cyclooxygenase inhibitors was associated with reduced risk for HGD and EAC independent of duration of therapy ( 58 ). By means of their antiproliferative, proapoptotic, antiangiogenic, and immunomodulatory eff ects, statins may prevent cancer development and growth.…”

Section: Summary Of Evidencementioning

confidence: 98%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,338

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 98%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,338

1,412

View full text Add to dashboard Cite

show abstract

“…A recently published meta-analysis showed that, overall, COX inhibitor use was associated with a reduced risk of OAC/HGD among patients with BO (RR 0.64, 95% CI 0.53 to 0.77). Both aspirin and non-aspirin COX inhibitors reduced the risk of OAC/HGD (RR 0.63, 95% CI 0.43 to 0.94 and RR 0.50, 95% CI 0.32 to 0.78, respectively) 192. However, the risk/benefit ratio of aspirin and NSAIDs is unclear, given the risk of GI bleeding and haemorrhagic stroke.…”

Section: Resultsmentioning

confidence: 99%

Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus

Fock

Talley

Goh

et al. 2016

Gut

153

214

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“…Experimentally statins inhibit proliferation and induce apoptosis in Barrett's cell lines and these effects are enhanced in an additive manner in combination with inhibition of the cyclo-oxygenase-2 pathway (10,11). Over-expression of COX-2 in Barrett's mucosa has been reported, and experimentally (34), and in clinical studies beneficial effects of COX-inhibitors on progression to cancer have been reported (13,16,(35)(36)(37). Thus it is possible that statin and aspirin impair survival of the Barrett's clone at a very early stage and so impair establishment of a mature Barrett's segment.…”

Section: Discussionmentioning

confidence: 99%