Z Gastroenterol 2010; 48 - A31
DOI: 10.1055/s-0030-1254769

The effect of aspirin treatment on the mucosal cyclooxigenase-2 (COX-2) activity in patients with Barrett's metaplasia: a follow up study

O Inczefi 1, I Németh 2, F Izbéki 1, R Róka 1, K Vadászi 1, L Tiszlavicz 2, T Wittmann 1, A Rosztóczy 1
  • 11st Department of Medicine, University of Szeged, Szeged, Hungary
  • 2Department of Pathology, University of Szeged, Szeged, Hungary

It is known that the increase of the COX-2 expression is an early step in the sequence of malignant transformations including Barrett's metaplasia and esophageal adenocarcinoma. Furthermore retrospective studies have shown a decreased incidence of esophageal adenocarcinoma in patients on aspirin treatment. Aim: to determine changes of COX-2 expression in patients with esophageal metaplasia after acetyl-salicylic acid + proton pump inhibitor (PPI) treatment compared to PPI treatment alone. Patients and Methods: 103 patients were studied prospectively (M/F: 52/51, mean age: 54 years (25–77)) with average follow-up time of 29 (7–60) months. Patients were submitted to upper gastrointestinal endoscopy and histology on enrolment and later at every 3–6-12 months, depending on the histological stage of the disease. Treatment arms were PPI + ASA (40mg pantoprazole b.i.d. + 300mg acetyl-salicylic acid) and PPI alone (40mg pantoprazole b.i.d.). The COX-2 activity was determined in the glandular mucosa by immunohistochemistry. The staining intensity was scored between 0 and 3 by 2 independent histologists. Primary endpoints were the change of COX-2 activity and the histological stage of the disease. Results: The COX-2 activity did not change significantly in the glandular mucosa in the studied treatment groups (PPI before/after: 1.8/1.9, PPI+ASA before/after: 2.0/2.1). Subgroup analysis of patients with intestinal and non-intestinal metaplasia yielded similar results. Further evaluation revealed a significant decrease in COX-2 activity in ASA treated male patients with intestinal metaplasia and low grade dysplasia (2.5/1.6, p<0.05). In contrast the COX-2 activity is somewhat increased in the control group (1.7/2.1, p=0.07). Conclusions: The administration of ASA had a limited effect on mucosal COX-2 activity in patients with esophageal metaplasia in the applied dose. Male patients with low grade dysplasia may benefit from this treatment. (UMFT-TÁMOP-4.2.2–08/01, 340/09-ETT)