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ToolsKo, Mie Thu, Rizwanullah, Agha, Jafri, Zain, Fung, Adriel and Alexandre, Leo (2025) Chemoprevention of Barrett's esophagus: A systematic review and comprehensive assessment of bias. Diseases of the Esophagus, 38 (4). ISSN 1120-8694
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Abstract
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.
| Item Type: | Article |
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| Additional Information: | 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. |
| Uncontrolled Keywords: | barrett's esophagus,chemoprevention,esophageal adenocarcinoma,high-grade dysplasia,gastroenterology ,/dk/atira/pure/subjectarea/asjc/2700/2715 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Gastroenterology and Gut Biology Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 22 Aug 2025 15:30 |
| Last Modified: | 22 Aug 2025 15:30 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/100224 |
| DOI: | 10.1093/dote/doaf062 |
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