Clinical—Alimentary TractMedications (NSAIDs, Statins, Proton Pump Inhibitors) and the Risk of Esophageal Adenocarcinoma in Patients With Barrett's Esophagus
Section snippets
Study Design
This was a nested case-control study, conducted in a cohort study of patients with BE identified in the VA health care system. The study was conducted using VA administrative records. The VA patient treatment file contains inpatient records, including demographic data, dates of admission and discharge, endoscopic procedures, vital status at discharge, and up to 10 discharge diagnoses (by International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9] codes) for all
Results
We identified 11,823 patients with a first-time BE diagnosis in the VA health care system between January 2000 and December 2002, who fulfilled the inclusion and exclusion criteria. In this cohort, we identified 116 cases with incident EAC and 696 controls without EAC who were matched in a 1:6 ratio on age and date of BE diagnosis as described in the Materials and Methods section. Demographic characteristics and information regarding filled prescriptions for cases and controls are shown in
Discussion
In this nested, matched, case-control study of patients with and without EAC in BE, we found that most (>90%) patients had at least one filled prescription for PPI. In this setting of almost universal PPI use among patients with BE, filled statin and NSAID/aspirin prescriptions were associated with a significant reduction in the risk of EAC. Each of these associations were independent of race, outpatient encounters, disease comorbidity index, NSAID/aspirin, socioeconomic status, or the use of
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This article has an accompanying continuing medical education activity on page e11. Learning Objective: Upon completion of these questions, successful learners will be able to learn about possible determinants (risk factors and protective factors) for Barrett's esophagus.
Conflicts of interest The authors disclose no conflicts.
Funding Supported by National Institutes of Health grant K24DK078154-03 and The Texas Gulf Coast Digestive Diseases Center (National Institutes of Health grant P50 DK56338) (H.B.E.-S.). Partly funded by Houston VA HSR&D Center of Excellence (HFP90-020).