Relationship between long‐term use of proton pump inhibitors and risk of gastric cancer: A systematic analysis

Abstract

Background and Aim:This study aims to systematically analyze the effect of long-term therapy with proton pump inhibitors (PPIs) on the risk of gastric cancer. Methods: PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and China biomedical literature database (CBM) were searched for studies before February 2019. We evaluated the quality of the included articles through the Newcastle-Ottawa Scale and gathered relevant data to calculate the pooled odds ratio (OR) through Stata14.0. Results: Seven relevant articles conformed to the inclusion criteria; 943 070 patients were included. The pooled OR was 2.50; 95% CI (1.74, 3.85); the subgroup analysis results showed that patients who had used PPIs for more than 36 months were most likely to develop gastric cancer, and an increased risk was observed among patients after Helicobacter pylori eradication. Noncardia gastric cancer was more likely to develop. Conclusions: Long-term use of PPIs can possibly increase the risk of gastric cancer even among patients after H. pylori eradication; in particular, for noncardia gastric cancer, the risk increases with longer durations of PPI use. Due to the limited number of studies, more high-quality studies are required to be designed. 7After H. pylori eradication H2RA, histamine 2 receptor antagonist; PPIs, proton pump inhibitors.

Advances in the diagnosis and management of gastroesophageal reflux disease

“…Proponents of population based epidemiology argue that the 3 year randomized controlled trial was still too small and too short to detect rare long term adverse events associated with PPI use. Instead they point to the many population based studies and meta-analyses of PPI risks summarized in table 3 8081828384858687888990919293949596979899100101. However, the mechanistic hypotheses that link these adverse outcomes to PPI use are without support from experimental studies.…”

Long-term proton pump inhibitor usage and the association with pancreatic cancer in Sweden

“…An increasing number of studies have also investigated the risk of cancer with most evidence existing for gastric, colorectal and pancreatic cancer. The two metaanalyses on gastric cancer (in total including 8 different studies) concluded that there may be an increased risk in particular when used over longer periods of time [20,21]. Yet, the two meta-analyses evaluating colorectal cancer (including 5 different studies) did not find strong support for an association [22,23], although 2 more studies have been published since showing a significantly increased risks [24,25].…”

Are proton pump inhibitors suitable medicines to prevent upper gastrointestinal events due to non-steroidal anti-inflammatory drugs?

“…PPIs are independent risk factors for small intestinal injury or exacerbated NSAIDsinduced small intestinal injury 2 . After the review was published, systematic review and/or meta-analysis reported that there were adverse effect of hepatic encephalopathy in advanced liver disease 3 , gastric cancer 4 , and myocardial infarction/stroke 5 , etc. I believe that, at least in countries where rebamipide 2 can be used, PPIs should not be used to prevent upper gastrointestinal events due to NSAIDs.…”