Aspirin and NSAIDs; benefits and harms for the gut

Best Practice & Research Clinical Gastroenterology , 05/04/2012

The authors address the current evidence base for aspirin use in gastrointestinal oncology, as well as several key questions surrounding its safety, cost effectiveness and optimal dose.

  • Despite modern advances in cancer research, screening and treatment options, gastrointestinal tumours remain a leading cause of death worldwide.
  • Both oesophageal and colorectal malignancies carry high rates of morbidity and mortality, presenting a challenge to clinicians in search of effective management strategies.
  • In recent years, the increasing burden of disease has led to a paradigm shift in the approach from treatment to prevention.
  • Among several agents postulated as having a chemopreventive effect on the gastrointestinal tract, aspirin has been most widely studied and has gained universal acknowledgement.
  • There is an expanding evidence base for aspirin as a key mediator in the prevention of dysplastic change in Barrett’s oesophagus and colorectal adenomas.
  • Its cardioprotective effects also impact positively on the patient population in question, many of whom have ischaemic vascular disease.
  • The major side effects of aspirin have been well-characterised and may cause significant morbidity and mortality in their own right.
  • Complications such as peptic ulceration, upper gastrointestinal bleeding and haemorrhagic stroke pose serious threats to the routine administration of aspirin and hence a balance between the risks and benefits must be struck if chemoprevention is to be effective on a large scale.

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