High Dose PPI + Aspirin in Barrett’s Esophagus

Esophageal carcinoma is the 6th most common cause of cancer with Barrett’s esophagus contributing to be the biggest risk factor. A randomized trial performed studied role of high-dose PPI and aspirin for  improving outcomes in patients with Barrett’s esophagus.

Patients with 1 cm or more of Barrett’s esophagus at 84 different centers in UK and Canada  were randomized 1:1:1:1  using a computerized schedule to receive high-dose ( 40 mg b.i.d.) or low-dose ( 20 mg qday) PPI with or without aspirin ( 325 mg) for at least 8 years in an unblinded manner.

Overall 705 patients were assigned the low-dose PPI and no aspirin, 704 were assigned high-dose PPI and no aspirin, 571 were assigned low-dose PPI and aspirin and 577 were assigned high-dose PPI and aspirin.  The treatment duration was for 8-9 years.

Results showed that combining high-dose PPI with aspirin had the strongest effect when compared with low-dose PPI without aspirin.  The numbers needed to treat were 34 for PPI and 43 for aspirin.

Hence the outcome showed that high-dose PPI and aspirin therapy in combination,  significantly and safely improved outcomes such as likelihood to die or develop esophageal cancer or high grade dysplasia in patients Barrett’s esophagus.

LOE = 1b

Jankowski JAZ, de Caestecker J, Love SB, et al. Esomeprazole and aspirin in Barrett’s oesophagus (AspECT): a randomised factorial trial. Lancet 2018;392(10145):400-408.