Gastroenterology

Gastroenterology

Volume 138, Issue 7, June 2010, Pages 2260-2266
Gastroenterology

Clinical—Alimentary Tract
Medications (NSAIDs, Statins, Proton Pump Inhibitors) and the Risk of Esophageal Adenocarcinoma in Patients With Barrett's Esophagus

https://doi.org/10.1053/j.gastro.2010.02.045Get rights and content

Background & Aims

Limited evidence suggests that proton pump inhibitors (PPI), nonsteroidal anti-inflammatory drugs (NSAID)/aspirin, and statins may be associated with a low risk of esophageal neoplasia. However, the possible effect these medications may have on the risk of esophageal adenocarcinoma (EAC) in patients with existing Barrett's esophagus (BE) is unclear.

Methods

We conducted a nested case-control study in a cohort of patients with BE identified in the national Department of Veterans' Affairs computerized databases. Cases with incident EAC were matched by incidence density sampling to controls with BE who remained without EAC at the date of the EAC diagnosis for the corresponding case. We identified prescriptions for PPI, NSAIDs/aspirin, and statins that were filled between BE diagnosis and EAC diagnosis. Incidence density ratios were calculated using conditional logistic regression models that adjusted for race, outpatient encounters, a disease comorbidity index, and socioeconomic status.

Results

In a cohort of 11,823 patients with first-time BE diagnosis, we examined 116 EAC cases and 696 matched controls. Most cases and controls had at least one filled PPI prescription (95% vs 94%; P = .5). In this setting of almost universal PPI use, filled NSAID/aspirin prescriptions were associated with a reduced risk of EAC (adjusted incidence density ratio, 0.64; 95% confidence interval, 0.42–0.97). Filled statin prescriptions also were associated with a reduction in EAC risk (0.55; 95% confidence interval, 0.36–0.86), with a significant trend toward greater risk reduction with longer duration of statin use. However, the strong inverse associations with even short periods of use raise concerns of uncontrolled confounding.

Conclusions

This observational study indicates that in patients with BE using PPI, NSAID/aspirin, or statin therapy might reduce the risk of developing EAC.

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

References (22)

  • M. Pera

    Trends in incidence and prevalence of specialized intestinal metaplasia, Barrett's esophagus, and adenocarcinoma of the gastroesophageal junction

    World J Surg

    (2003)
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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).

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