title: Nonsteroidal anti-inflammatory drugs and statins have chemopreventative effects in patients with Barrett's esophagus.
abstract: OBJECTIVE
  The incidence of Barrett's esophagus and esophageal adenocarcinoma has increased despite surveillance of patients with Barrett's esophagus. Limited data indicate that nonsteroidal anti-inflammatory drug (NSAID) and statin use reduce the risk for esophageal adenocarcinoma. We investigated whether NSAID or statin use reduces the risk of neoplastic progression from Barrett's esophagus.
  
  
  METHODS
  We performed a prospective study of 570 patients with Barrett's esophagus at 3 academic and 12 regional Dutch hospitals. Information on medication use was collected in patient interviews at each surveillance visit and cross-checked with pharmacy records. Patients completed a questionnaire about use of over-the-counter medication. Incident cases of high-grade dysplasia and adenocarcinoma were identified during the follow-up period.
  
  
  RESULTS
  During a median follow-up period of 4.5 years, 38 patients (7%) developed high-grade dysplasia or adenocarcinoma. After Barrett's esophagus had been diagnosed, 318 patients (56%) used NSAIDs for a median duration of 2 months, 161 (28%) used aspirin for a median duration of 5 years, 209 (37%) used statins for a median duration of 5 years, and 107 (19%) used NSAIDs and statins. NSAID and statin use were each associated with a reduced risk of neoplastic progression (hazard ratio [HR], 0.47; P = .030 and HR, 0.46; P = .048, respectively). Use of a combination of NSAIDs and statins increased the protective effect (HR, 0.22; P = .028).
  
  
  CONCLUSIONS
  NSAID and statin use reduce the risk of neoplastic progression in patients with Barrett's esophagus. Use of a combination of NSAIDs and statins appears to have an additive protective effect.
authors: Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. f.kastelein@erasmusmc.nl
authors: Florine
authors: F
authors: Kastelein
authors: Manon C W
authors: MC
authors: Spaander
authors: Katharina
authors: K
authors: Biermann
authors: Ewout W
authors: EW
authors: Steyerberg
authors: Ernst J
authors: EJ
authors: Kuipers
authors: Marco J
authors: MJ
authors: Bruno
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology; D001706:Biopsy; D015331:Cohort Studies; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors