Chemoprevention for patients with Barrett’s oesophagus remains a controversial topic. Results of the first randomized trial of chemoprevention using a proton pump inhibitor with or without aspirin were recently reported. We highlight strengths and weaknesses in the design of the trial and discuss the clinical implications of the findings.
Subscribe to Journal
Get full journal access for 1 year
only $17.75 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Jankowski, J. A. et al. Esomeprazole and aspirin in Barrett’s oesophagus (AspECT): a randomized factorial trial. Lancet 392, 400–408 (2018).
Singh, S. et al. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus: a systematic review and meta-analysis. Gut 63, 156–163 (2014).
Liao, L. M. et al. Nonsteroidal anti-inflammatory drug use reduces risk of adenocarcinomas of the esophagus and esophagogastric junction in a pooled analysis. Gastroenterology 142, 442–445 (2012).
Porta, N., Bonet, C. & Cobo, E. Discordance between reported intention-to-treat and per protocol analyses. J. Clin. Epidemiol. 60, 663–669 (2007).
Shaheen, N. J. et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am. J. Gastroenterol. 111, 30–50 (2016).
Fitzgerald, R. C. et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 63, 7–42 (2014).
Lazaras, B. et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern. Med 176, 238–246 (2016).
Xie, Y. et al. Proton pump inhibitors and risk of incident CKD and progression to ESRD. J. Am. Soc. Nephrol. 27, 1–11 (2016).
Haenisch, B. et al. Risk of dementia in elderly patients with the use of proton pump inhibitors. Eur. Arch. Psychiatry Clin. Neurosci. 265, 419–428 (2015).
Gomm, W. et al. Association of proton pump inhibitors with risk of dementia: a pharmoepidemiological claims data analysis. JAMA Neurol. 73, 410–416 (2016).
Freedberg, D. E., Kim, L. S. & Yang, Y. X. The risks and benefits of long-term use of proton pump inhibitors: expert review and best practice advice from the American Gastroenterological Association. Gastroenterology 152, 706–715 (2017).
The work of the authors is also supported in part by the NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Center for Gastrointestinal Development, Infection, and Injury (grant P30DK56338).
The authors declare no competing interests.
About this article
Cite this article
Husain, N.S., El-Serag, H.B. Chemoprevention of Barrett’s oesophagus: a step closer with PPIs and aspirin. Nat Rev Clin Oncol 15, 728–730 (2018). https://doi.org/10.1038/s41571-018-0096-x