Esomeprazole and aspirin in Barrett’s oesophagus

This randomised factorial trial aimed to evaluate the efficacy of high-dose esomeprazole proton-pump inhibitor and aspirin for improving outcomes in patients with Barrett’s oesophagus. Patients with Barrett’s oesophagus were randomised to receive high-dose (40 mg twice daily) or low-dose (20 mg once daily) PPI, with or without aspirin, for at least 8 years. Findings showed that high-dose PPI was superior to low-dose PPI, however aspirin was not significantly better than no aspirin. Combining high-dose PPI with aspirin had the strongest effect compared with low-dose PPI without aspirin (time ratio [TR] 1.59; 1.14 – 2.23). This trial was the largest RCT of PPIs and aspirin in Barrett’s oesophagus, and one of the longest aspirin chemoprevention trials with more than 20,000 patient-years of follow-up. High-dose PPI and aspirin chemoprevention therapy, especially in combination, significantly improved outcomes in patients with Barrett’s oesophagus, and a review of the current guidelines is warranted.

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