title: Aspirin and NSAIDs; benefits and harms for the gut.
abstract: Despite modern advances in cancer research, screening and treatment options, gastrointestinal tumours remain a leading cause of death worldwide. Both oesophageal and colorectal malignancies carry high rates of morbidity and mortality, presenting a challenge to clinicians in search of effective management strategies. In recent years, the increasing burden of disease has led to a paradigm shift in our approach from treatment to prevention. Among several agents postulated as having a chemopreventive effect on the gastrointestinal tract, aspirin has been most widely studied and has gained universal acknowledgement. There is an expanding evidence base for aspirin as a key mediator in the prevention of dysplastic change in Barrett's oesophagus and colorectal adenomas. Its cardioprotective effects also impact positively on the patient population in question, many of whom have ischaemic vascular disease. The major side effects of aspirin have been well-characterised and may cause significant morbidity and mortality in their own right. Complications such as peptic ulceration, upper gastrointestinal bleeding and haemorrhagic stroke pose serious threats to the routine administration of aspirin and hence a balance between the risks and benefits must be struck if chemoprevention is to be effective on a large scale. In this review, we address the current evidence base for aspirin use in gastrointestinal oncology, as well as several key questions surrounding its safety, cost effectiveness and optimal dose.
authors.affiliation: Department of Emergency Medicine, Balmoral Building, Leicester Royal Infirmary, London, UK. prarthana.thiagarajan@uhl-tr.nhs.uk
authors.forename: Prarthana
authors.initials: P
authors.lastname: Thiagarajan
authors.forename: Janusz A
authors.initials: JA
authors.lastname: Jankowski
mesh_terms: D000236:Adenoma / Q000517:prevention & control; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin