Taking aspirin in combination with proton-pump inhibitors (PPIs) reduces the risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus, according to research presented at the American Society of Clinical Oncology
Barrett’s oesophagus is a condition caused mainly by acid reflux, where the cells of the oesophagus grow abnormally. In a small number of people, these cells can develop into cancer. According to the researchers, oesophageal adenocarcinoma is the sixth most common cause of cancer death worldwide.
The researchers recruited 2,563 patients with ≥1cm of Barrett’s oesophagus but no high-grade dysplasia or oesophageal cancer at baseline in UK and Canadian hospitals. The patients were randomised to receive either high-dose (40mg twice daily) or low-dose (20mg once daily) esomeprazole PPI acid suppression alone, or combined with low-dose aspirin (300mg/day).
The patients were followed for almost nine years and studied whether they developed oesophageal cancer or worsened Barrett’s oesophagus, or if they died. Overall, 313 of the patients either developed oesophageal cancer or high-grade dysplasia, or died.
It was determined that high-dose PPI use was statistically significantly superior to low-dose PPI use. In addition, the combination of high-dose PPI and aspirin had the strongest effect, compared to low-dose PPI use with no aspirin, in reducing the risk of cancer.
The researchers said that while this was the largest randomised controlled chemoprevention trial in patients with Barrett’s oesophagus, further studies were required.
 Jankowski J, de Caestecker J, Love S et al. Chemoprevention of esophageal cancer with esomeprazole and aspirin therapy: efficacy and safety in the phase III randomized factorial ASPECT trial. Presented at the American Society of Clinical Oncology Annual Meeting, Chicago, Illinois. 1–5 June 2018. Abstract available at: https://meetinglibrary.asco.org/record/160062/abstract