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High-dose PPI and aspirin as chemoprevention in Barrett’s oesophagus
  1. Kuku Moyo,
  2. Teck K Khong, DTB Associate Editor
  1. Clinical Pharmacology, St George's University of London, London, UK
  1. Correspondence to Dr Teck K Khong, Clinical Pharmacology, St George's University of London, London, UK; tkhong{at}

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Review of: Jankowski J, et al. Esomeprazole and aspirin in Barrett’s oesophagus (AspECT): a randomised factorial trial. Lancet 2018;392:400–8.

Commentary by: Dr Moyo Kuku and Dr Teck Khong Clinical Pharmacology, St George's, University of London, London, UK

Series Editor: Dr Teck Khong, DTB Associate Editor Clinical Pharmacology, St George's, University of London, London, UK

Key learning points

  • Long-term use of very high-dose proton pump inhibitor treatment may reduce the composite endpoint of all-cause mortality, oesophageal adenocarcinoma or high-grade dysplasia in patients with Barrett’s oesophagus, particularly when combined with aspirin.

  • There was a small but statistically significant difference in the composite endpoint with esomeprazole 40 mg twice daily compared with esomeprazole 20 mg once daily after 8.9 years of follow-up.


The aspirin and esomeprazole chemoprevention in Barrett’s metaplasia trial (AspECT) found that a very high dose of a proton-pump inhibitor (PPI) and aspirin used for at least 9 years reduced the composite outcome compared with a standard dose of a PPI.1


This randomised phase III open-label factorial study was conducted in 84 centres in the UK and one in Canada to assess the effect of very high and standard doses of esomeprazole (40 mg twice daily or 20 mg once daily) taken with or without once daily aspirin (300 mg in the UK and 325 mg in Canada) for 10 years in patients aged 18 years or older with an established or new diagnosis of Barrett’s oesophagus (at least 1 cm …

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  • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

  • Provenance and peer review Commissioned; internally peer reviewed.