Use of Anti-Inflammatory Drugs and Lower Esophageal Sphincter–Relaxing Drugs and Risk of Esophageal and Gastric Cancers

• Published in: Clinical gastroenterology and hepatology Vol. 5; no. 10; pp. 1154 - 1159.e3
• Main Authors: Fortuny, Joan, Johnson, Christine C, Bohlke, Kari, Chow, Wong–Ho, Hart, Gene, Kucera, Gena, Mujumdar, Urvi, Ownby, Dennis, Wells, Karen, Yood, Marianne Ulcickas, Engel, Lawrence S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2007
• Subjects: Adenocarcinoma - chemically induced; Adenocarcinoma - epidemiology; Adenocarcinoma - pathology; Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Antidepressive Agents - adverse effects; Carcinoma, Squamous Cell - chemically induced; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - pathology; Esophageal Neoplasms - chemically induced; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - pathology; Esophagus - drug effects; Esophagus - physiopathology; Female; Follow-Up Studies; Gastroenterology and Hepatology; Histamine H1 Antagonists - adverse effects; Humans; Incidence; Male; Muscle Contraction - drug effects; Odds Ratio; Retrospective Studies; Risk Factors; Stomach Neoplasms - chemically induced; Stomach Neoplasms - epidemiology; Stomach Neoplasms - pathology; United States - epidemiology; United States; health maintenance organization; GHC; OR; COX-2; body mass index; CI; HFHS; PPI; Group Health Cooperative; Surveillance Epidemiology and End Results program; HMO; odds ratio; proton pump inhibitor; GERD; Henry Ford Health System; SEER; confidence interval; cyclooxygenase 2; gastroesophageal reflux disease; BMI
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2007.05.022

Background & Aims: The incidence of esophageal and gastric cardia adenocarcinoma has increased in Western countries in recent decades for largely unknown reasons. We investigated whether use of LES-relaxing drugs was related to an increased risk of esophageal and gastric cardia adenocarcinoma, and whether use of NSAIDs was related to a reduced risk of esophageal and gastric cancers. Methods: We examined these associations by using administrative databases in a case-control study in 2 integrated health care delivery systems. Cases were incident esophageal adenocarcinomas (n = 163) and squamous cell carcinomas (n = 114) and gastric cardia (n = 176) and non-cardia adenocarcinomas (n = 320), diagnosed between 1980–2002 in one health system and between 1993–2002 in the other. Matched controls (n = 3996) were selected. Complete prescription information was available for the study period. Results: Prescription of corticosteroids was associated with a decreased risk of esophageal adenocarcinoma (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.4–0.9), esophageal squamous cell carcinoma (OR, 0.4; 95% CI, 0.2–0.6), and gastric non-cardia carcinoma (OR, 0.4, 95% CI, 0.3–0.6). Ever use of pharmacy-purchased aspirin was associated with 30%–60% decreased risks of the studied cancers. As a group, LES-relaxing drugs showed little evidence of association with increased risk of any esophageal or gastric cancer. Conclusions: Corticosteroid and aspirin use were associated with significantly decreased risks of esophageal and gastric cancer. LES-relaxing drugs as a group did not affect these risks, although we had limited power to assess individual drugs. The possibility that corticosteroids and aspirin might reduce esophageal cancer risk warrants further consideration.