Aspirin and NSAIDs; benefits and harms for the gut
Best Practice & Research Clinical Gastroenterology , 05/04/2012
Thiagarajan P et al. – 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.