Aspirin, PPI Combo Reduces Esophageal Cancer Risk
In this study, the investigators aimed to expand the current understanding of the use of proton pump inhibitors (PPIs) and nonsteroidal anti-inflammatory drugs to prevent esophageal adenocarcinoma in patients with Barrett's esophagus (BE). To meet this aim, the investigators conducted a randomized, double-blind, placebo-controlled phase 2 trial to “assess the effects of the combination of aspirin (3 different doses) and esomeprazole on tissue concentrations of prostaglandin E2 (PGE2) in patients with BE with no dysplasia or low-grade dysplasia.”
Patients were randomly assigned to receive esomeprazole (40mg, 2X daily) in combination with an aspirin placebo (1X daily) (Arm A; n=42), with 81mg aspirin (1X daily) (Arm B; n=63), or with 325mg aspirin (1X daily) (Arm C; n=63) for 28 days. Esophageal biopsies were collected before and after the intervention period, and the absolute change in mean concentrations of PGE2 (the primary end point) were determined.
“The absolute mean tissue concentrations of PGE2 was reduced by 67.6±229.68pg/mL in Arm A, was reduced by 123.9±284.0pg/mL in Arm B (P=.10 vs Arm A), and was reduced by 174.9±263.62pg/mL in Arm C (P=.02 vs Arm A),” the investigators wrote.
The investigators concluded: “In combination with esomeprazole, short-term administration of higher doses of aspirin, but not lower doses or no aspirin, significantly reduced tissue concentrations of PGE2 patients with BE with either no dysplasia or low-grade dysplasia.”