Published online Apr 7, 2016. doi: 10.3748/wjg.v22.i13.3679
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.
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.