Aspirin has long been used to help prevent and manage heart disease. However, researchers at Baylor Scott & White Research Institute have discovered another potential benefit –protection against Barrett's esophagus, a disorder that causes damage to the esophagus from long-term acid reflux disease, and can help lower associated cancer risk.
The report, "Aspirin Prevents NF-κB Activation and CDX2 Expression Stimulated by Acid and Bile Salts in Oesophageal Squamous Cells of Barrett's Oesophagus Patients," was recently published in Gut, a top tier peer-reviewed journal.
"If you are predisposed to developing Barrett's esophagus, our research suggests that taking aspirin on a regular basis might prevent the condition from developing and the cancers that go along with it," said senior author Rhonda Souza, MD, co-director of the Center for Esophageal Research at Baylor Scott & White Research Institute.
Barrett's esophagus is a serious complication of chronic gastroesophageal reflux disease (GERD), a common condition where acid and other stomach enzymes reflux into the esophagus, causing damage. Some GERD patients develop Barrett's esophagus, in which the normal tissue lining of the esophagus changes to tissue that resembles the lining of the intestine. This can predispose people with Barrett's esophagus to a rare serious cancer called esophageal adenocarcinoma.
"We've seen a seven-fold increase in the frequency of esophageal adenocarcinoma in the last 40 years. It is relatively uncommon, but with its increasing frequency, it may not remain that way for long," said author Stuart Spechler, MD, co-director of the Center for Esophageal Research at Baylor Scott & White Research Institute.
Researchers haven't been able to pinpoint why certain GERD patients develop Barrett's esophagus while others do not, until now. To understand the mechanisms of the disease, the researchers examined the cells of GERD patients with and without Barrett's esophagus and treated the samples with acid and bile, common components that reflux up to the esophagus. When treated with these components, the researchers found differences in the molecular pathways of Barrett's esophagus patients, which could lead to the induction of CDX2, a gene associated with esophageal cancer.
While previous data associated NSAIDs, particularly aspirin, with certain GERD protections, the current study was the first to confirm that aspirin alone could inhibit the NF-κB pathway that promotes inflammation and CDX2 expression, which can lead to protection against Barrett's esophagus.
The researchers also discovered that aspirin could augment radiofrequency ablation (RFA), a new endoscopic procedure that burns away abnormal tissue associated with Barrett's esophagus and is offered through the Center for Esophageal Diseases at Baylor Scott & White Health. When treated with aspirin before and following the procedure, the researchers believe the drug could inhibit the regrowth of abnormal tissue in the esophagus, thereby preventing the condition from returning.
"For patients who have been shown to develop Barrett's, this research suggests that putting them on aspirin following the RFA procedure may delay or prevent the intestinal lining from returning," Dr. Souza said.
These novel findings have been used as a rationale in a National Institutes of Health (NIH)-funded clinical trial through MD Anderson Cancer Center, which is enrolling U.S. patients. The randomized control trial is looking at the role of aspirin in delaying or preventing Barrett's esophagus from recurring following RFA. Researchers from Baylor Scott & White Research Institute also are conducting the lab work to support the clinical study design of the trial. Patients interested in enrolling in the clinical trial can sign up through the NIH: https://clinicaltrials.gov/ct2/show/NCT02521285
This collaborative research is just one of many translational studies from Baylor Scott & White Research Institute. Award-winning scientists and medical professionals lead more than 2,000 research studies across the clinical spectrum that are designed to improve the care and well-being of the community, both nationally and internationally.
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As the largest not-for-profit health system in the state of Texas, Baylor Scott & White promotes the health and well-being of every individual, family and community it serves. It is committed to making quality care more accessible, convenient and affordable through its integrated delivery network, which includes the Baylor Scott & White Health Plan, Baylor Scott & White Research Institute, the Baylor Scott & White Quality Alliance and its leading digital health platform – MyBSWHealth. Through 51 hospitals and more than 1,200 access points, including flagship academic medical centers in Dallas, Fort Worth and Temple, the system offers the full continuum of care, from primary to award-winning specialty care. Founded as a Christian ministry of healing more than a century ago, Baylor Scott & White today serves more than three million Texans. For more information, visit: BSWHealth.com