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

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.