Oral Bisphosphonates and the Risk of Barrett's Esophagus: Case-Control Analysis of US Veterans
ABSTRACT OBJECTIVES:This study examined Barrett's esophagus (BE) risk factors in veterans to determine the association between risk of BE and use of oral bisphosphonates.METHODS:We conducted a case-control study among eligible patients scheduled for an elective esophagogastroduodenoscopy (EGD) and a sample of patients eligible for screening colonoscopy recruited from primary care clinics from a single VA Medical Center. Cases with definitive BE were compared with controls; all underwent study EGD. Use of oral bisphosphonates was ascertained by reviewing filled prescriptions in electronic pharmacy records. We calculated odds ratios (ORs) and 95% confidence intervals (95% CIs), using multivariate logistic regression modeling while adjusting for sex, age, race, proton-pump inhibitor use, hiatal hernia, waist-to-hip ratio, Helicobacter pylori infection, and gastroesophageal reflux disorder (GERD) symptoms.RESULTS:There were 285 BE cases, 1,122 endoscopy controls, and 496 primary care controls. Alendronate and risedronate were the only oral bisphosphonates prescribed. The proportion of BE cases with filled prescription of oral bisphosphonates (4.6%) was greater than in endoscopy controls (1.6%) or primary care controls (2.9%). In the adjusted analysis, oral bisphosphonate use was significantly associated with BE risk (OR=2.33; 95% CI: 1.11-4.88) compared with the combined control groups. This association remained significant when BE cases were compared with endoscopy controls only (OR=2.74; 95% CI: 1.28-5.87) but was attenuated when compared with primary care controls only (OR=2.60; 95% CI: 0.99-6.84). The association was observed in patients with GERD symptoms (OR=3.29; 95% CI: 1.36-7.97) but not in those without GERD symptoms.CONCLUSION:Oral bisphosphonate use may increase the risk for BE, especially among patients with GERD.Am J Gastroenterol advance online publication, 16 July 2013; doi:10.1038/ajg.2013.222.
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ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been suggested to protect against esophageal adenocarcinoma (EAC). This study examined the effect of NSAIDs on the risk of developing Barett's esophagus (BE), the precursor lesion to EAC. We conducted a case-control study among eligible patients scheduled for either elective esophagogastroduodenoscopy (EGD) or recruited from primary care clinics to undergo a study EGD. We compared 323 patients with BE (296 nondysplastic and 27 dysplastic) with 2 separate control groups: 1347 patients from the elective EGD group ("endoscopy controls") and 502 patients from the primary care group ("primary care controls") with no endoscopic or histopathologic BE. Use of aspirin products and 23 nonaspirin NSAIDs was ascertained from detailed, self-reported questionnaires. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic-regression models. There were no significant differences in self-reported NSAID use between all BE cases and all controls (58.2% vs. 54.6%, P=0.33); this was seen for aspirin products (43.0% vs. 37.4%, P=0.08) and nonaspirin NSAIDs (7.7% vs. 8.9%, P=0.46). These findings persisted in the multivariable model for any NSAIDs (adjusted OR 0.89; 95% CI 0.75-1.28), aspirin (adjusted OR 1.16; 95% CI 0.90-1.51), and nonaspirin NSAIDs (adjusted OR 0.88; 95% CI 0.55-1.39). Use of a combination of aspirin and nonaspirin NSAIDs was reported in 7.4% cases and 8.3% controls, and a non-significant inverse association with BE was seen (adjusted OR 0.70; 95% CI 0.44-1.11). There was no significant association between BE and daily NSAID use (adjusted OR 1.03; 95% CI 0.78-1.37). Similar findings were observed for comparisons involving nondysplastic or dysplastic BE cases, and endoscopy or primary care control groups separately or combined. The use of NSAIDs was not associated with a reduced risk of BE. It is likely that the protective mechanism of NSAIDs on EAC occurs subsequent to the development of BE.Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 04/2014; DOI:10.1016/j.cgh.2014.04.027 · 6.53 Impact Factor