Non-steroidal anti-inflammatory drugs, lower oesophageal sphincter-relaxing drugs and oesophageal cancer - A case-control study

Background and Aims: The incidence of oesophageal cancer has doubled in the last three decades. Non-steroidal anti-inflammatory drugs (NSAIDs) may be protective, whilst bronchodilators and calcium channel blockers that relax the lower oesophageal sphincter (LOS) may increase gastro-oesophageal reflux and the risk of oesophageal adenocarcinoma. We conducted a case-control study to examine the association between the use of NSAIDs and drugs which relax the LOS and the risk of oesophageal cancer. Methods: In Norfolk, 411 patients with a primary neoplasm of the oesophagus or cardia were matched with 1,644 controls with non-melanotic skin lesions. Data on the use of NSAIDs, bronchodilators and calcium channel blockers was collected. Results: Intake of NSAIDs was less in cases of oesophageal cancer as compared to the control group. The odds ratios (OR) and 95% confidence intervals (CI) for different NSAIDs were as follows: aspirin 0.35 (0.24-0.51); other NSAIDs 0.25 (0.16-0.40), and Cox-2 inhibitors 0.46 (0.20-0.94). LOS-relaxing drugs were consumed more frequently in cases of oesophageal cancer as compared to the controls. The OR for LOS-relaxing drugs was: inhaled bronchodilators 3.2 (95% CI 2.2-4.7); theophylline 1.9 (95% CI 1.3-5.1), and calcium channel blockers 2.4 (95% CI 1.2-5.0). Conclusion: Within the limitations of a case-control study using patients with non-melanotic skin lesions as controls, our results are consistent with the hypothesis that oesophageal cancer has a negative association with NSAID use, and a positive association with drugs that relax the LOS. Copyright (c) 2006 S. Karger AG, Basel.