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ACP Journal Club |20 November 2018

In Barrett esophagus, high- vs low-dose esomeprazole improved clinical outcomes; aspirin vs no aspirin did not

John K. Marshall, MD, MSc, FRCPC, AGAF

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Jankowski JA, de Caestecker J, Love SB, et al. Esomeprazole and aspirin in Barrett's oesophagus (AspECT): a randomised factorial trial. Lancet. 2018;392:400-8. 30057104

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Gastroenterology:

In Barrett esophagus (BE), does high- vs low-dose esomeprazole and aspirin vs no aspirin reduce all-cause mortality, esophageal adenocarcinoma, and high-grade dysplasia?
Randomized controlled 2 x 2 factorial trial (Aspirin and Esomeprazole Chemoprevention in Barrett's metaplasia Trial [AspECT]). EudraCT 2004-003836-77.
Concealed.*
Blinded* {pathologists evaluating adenocarcinoma and dysplasia outcomes}†.
Maximum 10 years (median 8.9 y).
84 centers in the UK and 1 center in Canada.
2557 patients ≥ 18 years of age (median age 59 y, 80% men) with BE (≥ 1 cm of columnar-lined esophagus confirmed by histology). Exclusion criteria included esophageal carcinoma, high-grade dysplasia, or use of nonsteroidal antiinflammatory drugs (NSAIDs).
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Marshall JK. In Barrett esophagus, high- vs low-dose esomeprazole improved clinical outcomes; aspirin vs no aspirin did not. Ann Intern Med. ;169:JC54. doi: 10.7326/ACPJC-2018-169-10-054

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Published: Ann Intern Med. 2018;169(10):JC54.

DOI: 10.7326/ACPJC-2018-169-10-054

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2018 American College of Physicians
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