A combination of esomeprazole and aspirin reduces tissue concentrations of prostaglandin E(2) in patients with Barrett's esophagus.
A combination of esomeprazole and aspirin reduces tissue concentrations of prostaglandin E(2) in patients with Barrett's esophagus.
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DOI：
10.1053/j.gastro.2012.06.044
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发表时间：
2012-10
期刊：
影响因子：
29.4
通讯作者：
Cancer Prevention Network
中科院分区：
文献类型：
--
作者：
Falk GW;Buttar NS;Foster NR;Ziegler KL;Demars CJ;Romero Y;Marcon NE;Schnell T;Corley DA;Sharma P;Cruz-Correa MR;Hur C;Fleischer DE;Chak A;Devault KR;Weinberg DS;Della'Zanna G;Richmond E;Smyrk TC;Mandrekar SJ;Limburg PJ;Cancer Prevention Network
质子泵抑制剂(PPI)和非类固醇抗炎药可以预防Barrett‘s Ereagus(BE)患者的食管腺癌，但临床试验支持这一概念的数据有限。我们进行了一项随机、双盲、安慰剂对照的II期试验，以评估阿司匹林(3种不同剂量)和埃索美拉唑对无不典型增生或低级别不典型增生的BE患者前列腺素E2(PGE2)组织浓度的影响。参与者通过多中心癌症预防网络招募，并被随机分配到服用埃索美拉唑(40毫克，每天两次)和阿司匹林安慰剂(每天一次)(A组；n=42)、阿司匹林81毫克(每天一次)(B组；n=63)或阿司匹林325毫克(每天一次)(C组；n=63)28天的组。我们收集了干预前后的食道活检组织，以确定PGE2(主要终点)平均浓度的绝对变化。基于114名患者的数据，不同组之间的基线特征相似。A组PGE_2绝对值降低67.6±229.68 pg/m L，B组减少123.9±284.0 pg/m L(P=0.10)，C组减少174.9±263.62 pg/m L(P=0.02 vs A组)。与埃索美拉唑联合使用，短期服用较高剂量的阿司匹林，但不服用较低剂量或不服用阿司匹林，可显著降低无不典型增生或低级别不典型增生的PGE2患者的组织浓度。这些数据支持进一步评估更高剂量的阿司匹林和埃索美拉唑预防这些患者食管腺癌的效果。
Proton pump inhibitors (PPIs) and nonsteroidal anti-inflammatory drugs might prevent esophageal adenocarcinoma in patients with Barrett’s esophagus (BE), but there are limited data from clinical trials to support this concept. We conducted a randomized, double-blind, placebo-controlled phase II trial to assess the effects of the combination of aspirin (3 different doses) and esomeprazole on tissue concentrations of prostaglandin E2 (PGE2) in patients with BE with no dysplasia or low-grade dysplasia. Participants were recruited through the multi-center Cancer Prevention Network and randomly assigned to groups that were given esomeprazole (40 mg, twice daily) in combination with an aspirin placebo (once daily) (Arm A; n=42), with 81 mg aspirin (once daily) (Arm B; n=63), or with 325 mg aspirin (once daily) (Arm C; n=63) for 28 days. We collected esophageal biopsies before and after the intervention period, to determine the absolute change in mean concentrations of PGE2 (the primary endpoint). Based on data from 114 patients, baseline characteristics were similar among groups. The absolute mean tissue concentrations of PGE2 was reduced by 67.6±229.68 pg/mL in Arm A, was reduced by 123.9±284.0 pg/mL in Arm B (P=.10 vs Arm A), and was reduced by 174.9 ±263.62 pg/mL in Arm C (P=.02 vs Arm A). In combination with esomeprazole, short-term administration of higher doses of aspirin, but not lower doses or no aspirin, significantly reduced tissue concentrations of PGE2 patients with BE with either no dysplasia or low-grade dysplasia. These data support further evaluation of higher doses of aspirin and esomeprazole to prevent esophageal adenocarcinoma in these patients.
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