Real-world evidence of the impact of aspirin use on esophageal cancer incidence in Barrett’s esophagus patients

This is the authors' abstract. We don't add key points for this paper.

Purpose: Barrett's esophagus (BE) is the main precursor to esophageal adenocarcinoma, a cancer with a significantly rising incidence. While proton-pump inhibitors (PPIs) are the standard therapy for managing BE, the chemopreventive role of aspirin is an area of growing interest with inconclusive evidence, particularly regarding its use in combination with PPIs. This study aimed to assess whether adding aspirin to PPI therapy reduces the incidence of esophageal cancer in patients with BE more than PPIs alone. Methods: A nationwide retrospective cohort study was conducted using the TriNetX database. Adult patients with BE were divided into two cohorts: those receiving aspirin plus a PPI and those receiving a PPI only. Propensity score matching was used to balance baseline demographics and clinical comorbidities. The primary outcome was the incidence of malignant neoplasm of the lower third of the esophagus. Subgroup analyses were also performed for low-dose (81 mg) and high-dose (300-325 mg) aspirin. Results: After matching, each cohort included 88,184 patients. The cohort receiving aspirin and PPIs had a lower risk of developing esophageal cancer compared to the PPI-only cohort (odds ratio [OR] 0.799, 95% CI: 0.679-0.941). The protective association was observed in both high-dose (OR 0.643) and low-dose (OR 0.664) aspirin subgroups, suggesting a potential dose-dependent effect. Conclusion: This large, real-world analysis suggests that the concurrent use of aspirin with PPIs is associated with a reduced risk of esophageal cancer in patients with BE.

In a large real-world cohort of patients with Barrett's esophagus, adding aspirin to PPI therapy was associated with a significantly reduced risk of developing esophageal cancer.