SURPRISINGLY ASPIRIN CAUSING GASTRITIS WITH PPI PREVENT CANCER IN BARRETT'S OESOPHAGUS
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Aspirin as a strong NSAID drug is known for gastritis and other ulcer in upper Gi tract but 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.
During the past two decades, beneficial effects from aspirin, statins, and non-steroidal anti-inflammatory drugs (NSAIDS) have been observed in epidemiological studies, initially as preventive medicine for cardiovascular disease. Protective effects have also been seen against several cancer types, including malignancies of the gastrointestinal tract. This protection was first described for colorectal cancer and later also for oesophageal adenocarcinoma.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 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.
Whether combination therapy should be offered for patients with Barrett's oesophagus, or even whether prophylactic treatment should be provided for patients with gastro-oesophageal reflux disease to prevent Barrett's oesophagus and reduce the risk of oesophageal adenocarcinoma, is still open for debate but aspirin with PPI showed good result only.
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