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Cyclooxygenase inhibitors use is associated with reduced risk of esophageal adenocarcinoma in patients with Barrett's esophagus: a meta-analysis.

Zhang S, Zhang XQ, Ding XW, Yang RK, Huang SL, Kastelein F, Bruno M, Yu XJ, Zhou D, Zou XP - Br. J. Cancer (2014)

Bottom Line: Overall, COX inhibitors use was associated with a reduced risk of EAC/HGD among BE patients (relative risk (RR)=0.64, 95% confidence interval (CI)=0.53-0.77).Cyclooxygenase inhibitors use is associated with a reduced risk of developing EAC in patients with BE.Both low-dose aspirin and non-aspirin COX inhibitors are associated with a reduced risk of neoplasia.

View Article: PubMed Central - PubMed

Affiliation: 1] Department of Gastroenterology, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China [2] Medical School of Nanjing University, Nanjing 210008, China.

ABSTRACT

Background: Esophageal adenocarcinoma (EAC) has high mortality and is increasing in incidence. Barrett's esophagus (BE) increases the risk for EAC. Studies have reported inconsistent findings on the association between use of cyclooxygenase (COX) inhibitors and the risk of neoplastic progression in BE patients. Therefore, we performed a meta-analysis to investigate this association.

Methods: A meta-analysis was undertaken among a total of 9 observational studies using fixed- and random-effects models, comprising 5446 participants; 605 had EAC or high-grade dysplasia (HGD).

Results: Overall, COX inhibitors use was associated with a reduced risk of EAC/HGD among BE patients (relative risk (RR)=0.64, 95% confidence interval (CI)=0.53-0.77). Aspirin use also reduced the risk of EAC/HGD (RR=0.63, 95% CI=0.43-0.94), as well as non-aspirin COX inhibitors (RR=0.50, 95% CI=0.32-0.78). The chemopreventive effect seemed to be independent of duration response.

Conclusions: Cyclooxygenase inhibitors use is associated with a reduced risk of developing EAC in patients with BE. Both low-dose aspirin and non-aspirin COX inhibitors are associated with a reduced risk of neoplasia. More well-designed randomised controlled trials are needed to increase our understanding of the chemopreventive effect of COX inhibitors.

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Related in: MedlinePlus

(A) Forest plot assessing overall COX inhibitors use and the risk of EAC/HGD in patients with BE. (B). Forest plot assessing overall COX inhibitors use and the risk of EAC only in patients with BE.
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fig2: (A) Forest plot assessing overall COX inhibitors use and the risk of EAC/HGD in patients with BE. (B). Forest plot assessing overall COX inhibitors use and the risk of EAC only in patients with BE.

Mentions: Altogether a smaller proportion of cases were prescribed COX inhibitors compared with controls (38.6% vs 39.7%). Patients with any exposure to any type of COX inhibitors had a significant risk reduction in developing EAC/HGD (adjusted RR=0.64, 95% CI=0.53–0.77, Phomogeneity=0.512) in an overall analysis using estimates adjusted for potential confounders in each study (Figure 2A). The unadjusted RR was also calculated (unadjusted RR=0.70, 95% CI=0.56–0.86, Phomogeneity=0.357).


Cyclooxygenase inhibitors use is associated with reduced risk of esophageal adenocarcinoma in patients with Barrett's esophagus: a meta-analysis.

Zhang S, Zhang XQ, Ding XW, Yang RK, Huang SL, Kastelein F, Bruno M, Yu XJ, Zhou D, Zou XP - Br. J. Cancer (2014)

(A) Forest plot assessing overall COX inhibitors use and the risk of EAC/HGD in patients with BE. (B). Forest plot assessing overall COX inhibitors use and the risk of EAC only in patients with BE.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4007227&req=5

fig2: (A) Forest plot assessing overall COX inhibitors use and the risk of EAC/HGD in patients with BE. (B). Forest plot assessing overall COX inhibitors use and the risk of EAC only in patients with BE.
Mentions: Altogether a smaller proportion of cases were prescribed COX inhibitors compared with controls (38.6% vs 39.7%). Patients with any exposure to any type of COX inhibitors had a significant risk reduction in developing EAC/HGD (adjusted RR=0.64, 95% CI=0.53–0.77, Phomogeneity=0.512) in an overall analysis using estimates adjusted for potential confounders in each study (Figure 2A). The unadjusted RR was also calculated (unadjusted RR=0.70, 95% CI=0.56–0.86, Phomogeneity=0.357).

Bottom Line: Overall, COX inhibitors use was associated with a reduced risk of EAC/HGD among BE patients (relative risk (RR)=0.64, 95% confidence interval (CI)=0.53-0.77).Cyclooxygenase inhibitors use is associated with a reduced risk of developing EAC in patients with BE.Both low-dose aspirin and non-aspirin COX inhibitors are associated with a reduced risk of neoplasia.

View Article: PubMed Central - PubMed

Affiliation: 1] Department of Gastroenterology, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China [2] Medical School of Nanjing University, Nanjing 210008, China.

ABSTRACT

Background: Esophageal adenocarcinoma (EAC) has high mortality and is increasing in incidence. Barrett's esophagus (BE) increases the risk for EAC. Studies have reported inconsistent findings on the association between use of cyclooxygenase (COX) inhibitors and the risk of neoplastic progression in BE patients. Therefore, we performed a meta-analysis to investigate this association.

Methods: A meta-analysis was undertaken among a total of 9 observational studies using fixed- and random-effects models, comprising 5446 participants; 605 had EAC or high-grade dysplasia (HGD).

Results: Overall, COX inhibitors use was associated with a reduced risk of EAC/HGD among BE patients (relative risk (RR)=0.64, 95% confidence interval (CI)=0.53-0.77). Aspirin use also reduced the risk of EAC/HGD (RR=0.63, 95% CI=0.43-0.94), as well as non-aspirin COX inhibitors (RR=0.50, 95% CI=0.32-0.78). The chemopreventive effect seemed to be independent of duration response.

Conclusions: Cyclooxygenase inhibitors use is associated with a reduced risk of developing EAC in patients with BE. Both low-dose aspirin and non-aspirin COX inhibitors are associated with a reduced risk of neoplasia. More well-designed randomised controlled trials are needed to increase our understanding of the chemopreventive effect of COX inhibitors.

Show MeSH
Related in: MedlinePlus