Primary prevention
In one case-controlled study, current aspirin users had a reduced risk of Barrett's oesophagus compared with non-users (odds ratio 0.56, 95 % confidence interval 0.39-0.80).[31] Results were similar in a subset of patients who had endoscopies for GORD symptoms. No interactions were found between aspirin use and smoking or proton-pump inhibitor (PPI) use.[31] However, because of a lack of conclusive evidence demonstrating a true chemopreventive effect of aspirin or non-steroidal anti-inflammatory drugs, as well as the potential adverse events associated with these therapies, their use is currently not routinely recommended.[1][7][32] The National Institute for Health and Care Excellence (NICE) in the UK recommends against using aspirin to prevent progression to oesophageal dysplasia and cancer in patients with Barrett's oesophagus.[33]
Secondary prevention
The only chemopreventive strategy currently endorsed by guidelines is long-term (usually indefinite) use of once daily oral proton-pump inhibitor (PPI). This recommendation is based on results from a meta-analysis summarising data from several observational studies. The data demonstrated that PPI use was associated with reduced risk of high-grade dysplasia and neoplastic progression in patients with Barrett's oesophagus.[7]
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