TY - JOUR
T1 - Chemoprevention of Barrett's esophagus: A systematic review and comprehensive assessment of bias
AU - Ko, Mie Thu
AU - Rizwanullah, Agha
AU - Jafri, Zain
AU - Fung, Adriel
AU - Alexandre, Leo
N1 - Data availability: The dataset is available from the corresponding author.
Financial support: Mie Thu Ko, NIHR Academic Clinical Fellow, is funded by the National Institute for Health Research (NIHR) for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care.
PY - 2025/8
Y1 - 2025/8
N2 - Chemoprevention of Barrett's esophagus (BE) represents an opportunity to reduce the burden of esophageal adenocarcinoma (EAC). We conducted a systematic review and meta-analysis to evaluate the assumed causal association between proton-pump inhibitors (PPIs), aspirin and statins, and BE progression, and undertook a comprehensive risk of bias (RoB) assessment. The protocol was prospectively registered (PROSPERO ID: CRD42024532338). Sixteen observational studies and one randomized controlled trial were identified. PPIs and statins were associated with a 54% (adjusted OR 0.46; 95% CI 0.25-0.86; P = 0.02) and 47% (adjusted OR 0.53; 95% CI 0.37-0.74; P < 0.001) reduced odds of progression, and aspirin use was not significantly associated (adjusted OR 0.84; 95% CI 0.65-1.08; P = 0.17). Among observational studies, 6 were at critical RoB and 10 were at serious RoB. The only trial included was at low RoB and reported no significant associations for aspirin and PPI comparisons and high-grade dysplasia (HGD)/EAC. The Grading of Recommendations, Assessment, Development and Evaluations certainty of evidence was very low. All observational studies were at serious or critical RoB. Trial evidence was at low RoB and did not demonstrate any significant differences between aspirin and PPI comparisons for the outcome of HGD/EAC. Given the very low certainty of evidence, there is little rationale to recommend these medications for chemoprevention in BE.
AB - Chemoprevention of Barrett's esophagus (BE) represents an opportunity to reduce the burden of esophageal adenocarcinoma (EAC). We conducted a systematic review and meta-analysis to evaluate the assumed causal association between proton-pump inhibitors (PPIs), aspirin and statins, and BE progression, and undertook a comprehensive risk of bias (RoB) assessment. The protocol was prospectively registered (PROSPERO ID: CRD42024532338). Sixteen observational studies and one randomized controlled trial were identified. PPIs and statins were associated with a 54% (adjusted OR 0.46; 95% CI 0.25-0.86; P = 0.02) and 47% (adjusted OR 0.53; 95% CI 0.37-0.74; P < 0.001) reduced odds of progression, and aspirin use was not significantly associated (adjusted OR 0.84; 95% CI 0.65-1.08; P = 0.17). Among observational studies, 6 were at critical RoB and 10 were at serious RoB. The only trial included was at low RoB and reported no significant associations for aspirin and PPI comparisons and high-grade dysplasia (HGD)/EAC. The Grading of Recommendations, Assessment, Development and Evaluations certainty of evidence was very low. All observational studies were at serious or critical RoB. Trial evidence was at low RoB and did not demonstrate any significant differences between aspirin and PPI comparisons for the outcome of HGD/EAC. Given the very low certainty of evidence, there is little rationale to recommend these medications for chemoprevention in BE.
KW - Barrett's esophagus
KW - chemoprevention
KW - esophageal adenocarcinoma
KW - high-grade dysplasia
UR - https://www.scopus.com/pages/publications/105013142618
U2 - 10.1093/dote/doaf062
DO - 10.1093/dote/doaf062
M3 - Review article
C2 - 40794904
AN - SCOPUS:105013142618
SN - 1120-8694
VL - 38
JO - Diseases of the Esophagus
JF - Diseases of the Esophagus
IS - 4
M1 - doaf062
ER -