From the Guidelines
NSAIDs are not contraindicated in patients with Barrett's esophagus, but their use should be approached with caution due to potential gastrointestinal risks. According to the British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus 1, there is currently insufficient evidence to support the use of aspirin, NSAIDs, or other chemopreventive agents in patients with Barrett's esophagus. However, patients with Barrett's esophagus can use NSAIDs when necessary, but should do so under medical supervision and with certain precautions.
When using NSAIDs, patients should:
- Take them with food or milk to reduce stomach irritation
- Use the lowest effective dose for the shortest duration possible
- Consider using a proton pump inhibitor (PPI) like omeprazole 20mg daily while taking NSAIDs Patients should be aware that NSAIDs can potentially irritate the esophagus and increase reflux, which may exacerbate Barrett's esophagus symptoms. However, the primary concern with NSAIDs is their potential to cause gastric ulcers and bleeding, rather than directly affecting Barrett's esophagus. The American Gastroenterological Association medical position statement on the management of Barrett's esophagus also suggests that while NSAIDs may decrease the incidence of esophageal cancer, it is not clear that this potential benefit outweighs the risks of the medications 1. If long-term NSAID use is required, regular endoscopic monitoring may be recommended to check for any changes or complications in the esophagus, as suggested by the British Society of Gastroenterology guidelines 1. Patients should always inform their gastroenterologist about any NSAID use, including over-the-counter medications.
From the Research
NSAIDs and Barrett's Esophagus
- The use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in patients with Barrett's esophagus is a topic of ongoing research, with some studies suggesting a potential benefit in reducing the risk of progression to esophageal adenocarcinoma 2, 3.
- However, other studies have found no significant association between NSAID use and a reduced risk of Barrett's esophagus 4, 5, 6.
- A study published in 2018 found that the inverse associations between aspirin/NSAID use and esophageal adenocarcinoma may be the result of reducing neoplastic progression rather than initiation of Barrett's esophagus 2.
- Another study published in 2015 found that use of NSAIDs, statins, low-dose aspirin, and PPIs did not reduce the risk of oesophageal adenocarcinoma among patients with Barrett's oesophagus 6.
Contraindications
- There is no clear evidence to suggest that NSAIDs are contraindicated in patients with Barrett's esophagus, but the potential risks of gastrointestinal bleeding, complicated ulcer disease, and hemorrhagic stroke should be considered 2.
- The decision to use NSAIDs in patients with Barrett's esophagus should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 2, 3.
Chemoprevention
- Some studies suggest that NSAIDs and statins may have chemopreventative effects in patients with Barrett's esophagus, reducing the risk of neoplastic progression 3.
- However, more research is needed to fully understand the potential benefits and risks of chemoprevention in patients with Barrett's esophagus 2, 6.