Chemoprevention and Barrett's esophagus: decisions, decisions.

The incidence of esophageal adenocarcinoma continues to increase at a rate greater than that of any other cancer in the western world. Current strategies to deal with this situation are problematic, and the time has come for new approaches to this problem. Chemoprevention is one such approach. In this issue of the American Journal of Gastroenterology, Hur et al. examined Barrett's esophagus patient preferences for cancer chemoprevention with either aspirin or celecoxib. They found that 93% of their patients were willing to take one of these two drugs, but that nearly five times as many patients preferred aspirin to celecoxib (76%vs 15%). The most important reason for willingness to use celecoxib or aspirin was cancer prevention, while the most important reason for not using celecoxib was risk of myocardial infarction and for aspirin gastrointestinal adverse events. While this study indicates that there is a strong interest among Barrett's esophagus patients for chemoprevention, it is still premature for our patients to embark on such an approach. The role of chemoprevention in Barrett's esophagus still awaits the results of ongoing clinical trials in the United Kingdom and North America.