Tsibouris P, Hendrickse M T, Isaacs P E T
Blackpool Victoria Hospital, Blackpool, UK.
Aliment Pharmacol Ther. 2004 Sep 15;20(6):645-55. doi: 10.1111/j.1365-2036.2004.02150.x.
Non-steroidal anti-inflammatory drugs use may protect against development of oesophageal adenocarcinoma.
To define the consequences of non-steroidal anti-inflammatory drugs use in patients with Barrett's oesophagus.
Records of all Barrett's oesophagus/oesophageal adenocarcinoma patients examined in Blackpool-Wyre-Fylde area were reviewed. All surviving patients completed validated questionnaires.
Use of non-steroidal anti-inflammatory drugs of any type and at any frequency was more prevalent in Barrett's oesophagus patients [147 (38%) Barrett's oesophagus vs. 30 (26%) oesophageal adenocarcinoma, P = 0.02]. Daily use of non-steroidal anti-inflammatory drugs was more prevalent in Barrett's oesophagus patients [88 (23%) Barrett's oesophagus vs. 14 (12%) oesophageal adenocarcinoma, P = 0.02], due to more prevalent consumption of non-aspirin non-steroidal anti-inflammatory drugs [48 (13%) Barrett's oesophagus vs. four (4%) oesophageal adenocarcinoma, P = 0.009]. There was no difference between the two groups in usage of either daily low-dose aspirin or of occasional non-steroidal anti-inflammatory drugs. In logistic regression analysis any use of non-steroidal anti-inflammatory drugs [odds ratio (OR) = 0571 (95% CI: 0.359-0.909), P = 0.018] and daily use of non-aspirin non-steroidal anti-inflammatory drugs [OR = 0.297 (95% CI: 0.097-0.911), P = 0.034] were significant protective factors. Non-steroidal anti-inflammatory drugs use did not affect the survival of oesophageal adenocarcinoma patients. Oesophageal adenocarcinoma and Barrett's oesophagus consuming non-steroidal anti-inflammatory drugs did not differ in upper gastrointestinal bleeding [26 (15%) non-steroidal anti-inflammatory drugs consumers vs. 29 (9%) non-consumers, P = 0.08], oesophageal ulcers [31 (18%) non-steroidal anti-inflammatory drug consumers vs. 49 (15%) non-consumers, P = 0.43] or stricturing [19 (11%) non-steroidal anti-inflammatory drug consumers vs. 41 (13%) non-consumers, P = 0.58].
(i) Daily use of non-steroidal anti-inflammatory drugs is more prevalent in Barrett's oesophagus than oesophageal adenocarcinoma patients, because of a more prevalent use of non-aspirin non-steroidal anti-inflammatory drugs. (ii) Use of non-steroidal anti-inflammatory drugs in Barrett's oesophagus patients is safe if acid suppression is adequate.
使用非甾体抗炎药可能预防食管腺癌的发生。
明确巴雷特食管患者使用非甾体抗炎药的后果。
回顾在布莱克浦-怀尔-菲尔德地区接受检查的所有巴雷特食管/食管腺癌患者的记录。所有存活患者均完成了经过验证的问卷调查。
在巴雷特食管患者中，任何类型及任何频率使用非甾体抗炎药的情况更为普遍[147例（38%）巴雷特食管患者 vs. 30例（26%）食管腺癌患者，P = 0.02]。巴雷特食管患者中每日使用非甾体抗炎药更为普遍[88例（23%）巴雷特食管患者 vs. 14例（12%）食管腺癌患者，P = 0.02]，这是由于非阿司匹林类非甾体抗炎药的使用更为普遍[48例（13%）巴雷特食管患者 vs. 4例（4%）食管腺癌患者，P = 0.009]。两组在每日低剂量阿司匹林或偶尔使用非甾体抗炎药的使用情况上无差异。在逻辑回归分析中，任何非甾体抗炎药的使用[比值比（OR）= 0.571（95%可信区间：0.359 - 0.909），P = 0.018]以及每日使用非阿司匹林类非甾体抗炎药[OR = 0.297（95%可信区间：0.097 - 0.911），P = 0.034]均为显著的保护因素。非甾体抗炎药的使用并未影响食管腺癌患者的生存率。使用非甾体抗炎药的食管腺癌和巴雷特食管患者在上消化道出血方面无差异[26例（15%）使用非甾体抗炎药者 vs. 29例（9%）未使用者，P = 0.08]，在食管溃疡方面无差异[31例（18%）使用非甾体抗炎药者 vs. 49例（15%）未使用者，P = 0.43]，在狭窄方面也无差异[19例（11%）使用非甾体抗炎药者 vs. 41例（13%）未使用者，P = 0.58]。
（i）由于非阿司匹林类非甾体抗炎药的使用更为普遍，巴雷特食管患者中每日使用非甾体抗炎药的情况比食管腺癌患者更为普遍。（ii）如果抑酸充分，巴雷特食管患者使用非甾体抗炎药是安全的。
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