Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2016; 22(13): 3679-3686
Published online Apr 7, 2016. doi: 10.3748/wjg.v22.i13.3679
Does aspirin or non-aspirin non-steroidal anti-inflammatory drug use prevent colorectal cancer in inflammatory bowel disease?
Nick E Burr, Mark A Hull, Venkataraman Subramanian
Nick E Burr, Mark A Hull, Venkataraman Subramanian, Leeds Institute for Biomedical and Clinical Sciences, St James’s University Hospital, University of Leeds, LS9 7TF Leeds, United Kingdom
Author contributions: Burr N and Subramanian V designed and performed the research and prepared the manuscript; Hull MA contributed to the design of the research and preparation of the manuscript.
Conflict-of-interest statement: Dr. Burr N and Dr. Subramanian V have no competing interests to declare. Prof. Hull MA has acted as an advisory board member for discussion about aspirin for colorectal cancer chemoprevention in 2010 and 2013 (Bayer AG). Bayer AG also provide aspirin 300 mg tablets and placebo free of charge for an investigator-led, publicly-funded randomized clinical trial (seafood Polyp Prevention Trial) for which Prof. Hull MA is the Chief Investigator.
Data sharing statement: Technical appendix, statistical code, and extracted dataset available from the corresponding author at
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Venkataraman Subramanian, MD, DM, MRCP, Leeds Institute for Biomedical and Clinical Sciences, St James’s University Hospital, University of Leeds, LS9 7TF Leeds, United Kingdom.
Telephone: +44-113-2068691 Fax: +44-113-2068688
Received: December 29, 2015
Peer-review started: December 30, 2015
First decision: January 28, 2016
Revised: February 9, 2016
Accepted: March 2, 2016
Article in press: March 2, 2016
Published online: April 7, 2016

AIM: To determine whether aspirin or non-aspirin non-steroidal anti-inflammatory drugs (NA-NSAIDs) prevent colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD).

METHODS: We performed a systematic review and meta-analysis. We searched for articles reporting the risk of CRC in patients with IBD related to aspirin or NA-NSAID use. Pooled odds ratios (OR) and 95%CIs were determined using a random-effects model. Publication bias was assessed using Funnel plots and Egger’s test. Heterogeneity was assessed using Cochran’s Q and the I2 statistic.

RESULTS: Eight studies involving 14917 patients and 3 studies involving 1282 patients provided data on the risk of CRC in patients with IBD taking NA-NSAIDs and aspirin respectively. The pooled OR of developing CRC after exposure to NA-NSAIDs in patients with IBD was 0.80 (95%CI: 0.39-1.21) and after exposure to aspirin it was 0.66 (95%CI: 0.06-1.39). There was significant heterogeneity (I2 > 50%) between the studies. There was no change in the effect estimates on subgroup analyses of the population studied or whether adjustment or matching was performed.

CONCLUSION: There is a lack of high quality evidence on this important clinical topic. From the available evidence NA-NSAID or aspirin use does not appear to be chemopreventative for CRC in patients with IBD.

Keywords: Inflammatory bowel disease, Aspirin, Non-steroidal anti-inflammatory, Colorectal cancer, Chemoprevention

Core tip: Colorectal cancer (CRC) remains a serious complication of inflammatory bowel disease (IBD) and chemoprevention is an attractive alternative to prophylactic surgery or intensive surveillance programs. Aspirin and non-steroidal anti-inflammatory drugs have chemopreventative activity against “sporadic” CRC. We have synthesized the available data for the prevention of IBD associated CRC and found no potential protective effect for either medication. There is a lack of available data on the potential effects of these medications in preventing CRC in patients with IBD and there is a need for high quality, focused studies on this topic.