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Medline ® Abstract for Reference 64

of 'Barrett's esophagus: Surveillance and management'

64
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Nonsteroidal anti-inflammatory drugs and statins have chemopreventative effects in patients with Barrett's esophagus.
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Kastelein F, Spaander MC, Biermann K, Steyerberg EW, Kuipers EJ, Bruno MJ, Probar-study Group
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Gastroenterology. 2011 Dec;141(6):2000-8; quiz e13-4. Epub 2011 Aug 28.
 
BACKGROUND& AIMS: The incidence of Barrett's esophagus and esophageal adenocarcinoma has increased despite surveillance of patients with Barrett's esophagus. Limited data indicate that nonsteroidal anti-inflammatory drug (NSAID) and statin use reduce the risk for esophageal adenocarcinoma. We investigated whether NSAID or statin use reduces the risk of neoplastic progression from Barrett's esophagus.
METHODS: We performed a prospective study of 570 patients with Barrett's esophagus at 3 academic and 12 regional Dutch hospitals. Information on medication use was collected in patient interviews at each surveillance visit and cross-checked with pharmacy records. Patients completed a questionnaire about use of over-the-counter medication. Incident cases of high-grade dysplasia and adenocarcinoma were identified during the follow-up period.
RESULTS: During a median follow-up period of 4.5 years, 38 patients (7%) developed high-grade dysplasia or adenocarcinoma. After Barrett's esophagus had been diagnosed, 318 patients (56%) used NSAIDs for a median duration of 2 months, 161 (28%) used aspirin for a median duration of 5 years, 209 (37%) used statins for a median duration of 5 years, and 107 (19%) used NSAIDs and statins. NSAID and statin use were each associated with a reduced risk of neoplastic progression (hazard ratio [HR], 0.47; P = .030 and HR, 0.46; P = .048, respectively). Use of a combination of NSAIDs and statins increased the protective effect (HR, 0.22; P = .028).
CONCLUSIONS: NSAID and statin use reduce the risk of neoplastic progression in patients with Barrett's esophagus. Use of a combination of NSAIDs and statins appears to have an additive protective effect.
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Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. f.kastelein@erasmusmc.nl
PMID