Section of Gastroenterology and Section of Health Services Research, Houston Department of Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA.
Gastroenterology. 2010 Jun;138(7):2260-6. doi: 10.1053/j.gastro.2010.02.045. Epub 2010 Feb 23.
BACKGROUND & AIMS: Limited evidence suggests that proton pump inhibitors (PPI), nonsteroidal anti-inflammatory drugs (NSAID)/aspirin, and statins may be associated with a low risk of esophageal neoplasia. However, the possible effect these medications may have on the risk of esophageal adenocarcinoma (EAC) in patients with existing Barrett's esophagus (BE) is unclear.
We conducted a nested case-control study in a cohort of patients with BE identified in the national Department of Veterans' Affairs computerized databases. Cases with incident EAC were matched by incidence density sampling to controls with BE who remained without EAC at the date of the EAC diagnosis for the corresponding case. We identified prescriptions for PPI, NSAIDs/aspirin, and statins that were filled between BE diagnosis and EAC diagnosis. Incidence density ratios were calculated using conditional logistic regression models that adjusted for race, outpatient encounters, a disease comorbidity index, and socioeconomic status.
In a cohort of 11,823 patients with first-time BE diagnosis, we examined 116 EAC cases and 696 matched controls. Most cases and controls had at least one filled PPI prescription (95% vs 94%; P = .5). In this setting of almost universal PPI use, filled NSAID/aspirin prescriptions were associated with a reduced risk of EAC (adjusted incidence density ratio, 0.64; 95% confidence interval, 0.42-0.97). Filled statin prescriptions also were associated with a reduction in EAC risk (0.55; 95% confidence interval, 0.36-0.86), with a significant trend toward greater risk reduction with longer duration of statin use. However, the strong inverse associations with even short periods of use raise concerns of uncontrolled confounding.
This observational study indicates that in patients with BE using PPI, NSAID/aspirin, or statin therapy might reduce the risk of developing EAC.
有限的证据表明质子泵抑制剂（PPI）、非甾体抗炎药（NSAID）/阿司匹林和他汀类药物可能与食管肿瘤发生的低风险相关。然而，这些药物对存在 Barrett 食管（BE）的患者发生食管腺癌（EAC）的风险可能产生的影响尚不清楚。
我们在国家退伍军人事务部计算机数据库中确定的 BE 患者队列中进行了一项嵌套病例对照研究。通过按发病率密度抽样法，将 EAC 新发病例与 BE 患者中在相应病例 EAC 诊断日期时仍未发生 EAC 的患者进行匹配。我们确定了在 BE 诊断和 EAC 诊断之间开具的 PPI、NSAID/阿司匹林和他汀类药物的处方。使用条件逻辑回归模型计算发病率密度比，该模型调整了种族、门诊就诊次数、疾病合并症指数和社会经济状况。
在首次诊断为 BE 的 11823 例患者队列中，我们检查了 116 例 EAC 病例和 696 例匹配的对照。大多数病例和对照都至少有一张 PPI 处方（95% vs 94%；P =.5）。在这种几乎普遍使用 PPI 的情况下，使用 NSAID/阿司匹林处方与 EAC 风险降低相关（调整后的发病率密度比为 0.64；95%置信区间，0.42-0.97）。他汀类药物的使用也与 EAC 风险降低相关（0.55；95%置信区间，0.36-0.86），且随着他汀类药物使用时间的延长，风险降低的趋势更为显著。然而，即使是短期使用也与强烈的负相关关系引起了对未控制混杂因素的担忧。
这项观察性研究表明，在使用 PPI、NSAID/阿司匹林或他汀类药物治疗的 BE 患者中，这些药物可能降低发生 EAC 的风险。
