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The Aspirin Esomeprazole Chemoprevention Trial (AspECT) is to our knowledge one of the largest cancer prevention trials using aspirin and acid suppression in the world. In total 2557 patients with a common precancerous change in their oesophagus, called Barrett’s oesophagus, were followed up for an average of 9 years resulting in over 20,000 life-years of follow up. After informed written consent, patients were randomly allocated to four different combinations; Low acid suppression alone, High acid suppression alone, low acid suppression with 300mg aspirin and high acid suppression with 300mg aspirin. We wanted to see if we could prevent progression to local cancer/cancer in-situ (high grade dysplasia), invasive cancer or prevent death by all causes both cancer and non-cancer.

The main findings of the trial were that:

a) High dose acid suppression significantly prevented progression to high grade dysplasia, cancer and especially all causes of mortality.

b) Aspirin also had an effect on these endpoints but only when patients who received non-steroidal anti-inflammatory drugs e.g. brufen were removed from the analysis prior to use.

c) The combination of high dose acid suppression and aspirin had a combinatorial effect i.e. worked better than either alone.

d) The safety of these agents over the 9 years was exceptional as <1% of patients had serious adverse events linked to the medications.

In summary we showed that taking high dose acid suppression significantly benefitted 1 in 34 patients in this way whereas aspirin benefitted 1 in 43 patients. This trial is also unique in that it looked at the combination of cancer prevention agents. The trial is now being assessed by the National Institute for Health and Care Excellence in the UK to see if National Guidelines need to change.

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