BMJ Open | October 31, 2017
Brusselaers N, et al. – In Sweden, a nationwide population-based cohort study is performed to evaluate the risk of gastric cancer-related to proton pump inhibitor (PPI) use, considering underlying signs. The outcome suggests that the long-term PPI use might be an independent risk factor for gastric cancer. This challenges broad maintenance PPI therapy, especially if the sign is feeble.
Methods
- For this research, they designed a population-based cohort study.
- Standardised incidence ratios (SIRs) and 95% CIs were calculated to compare the risk of gastric cancer among long-term PPI users with the corresponding background population, while taking confounding by indication into account.
- This study was conducted in Sweden (2005-2012).
- This study included virtually all adults residing in Sweden exposed to maintenance therapy with PPIs.
Results
- Among 7,97,067 individuals on maintenance PPI therapy, the SIR of gastric cancer was over threefold increased (SIR=3.38, 95%CI 3.23 to 3.53).
- Increased SIRs were found in both sexes and all age groups, but were particularly increased among PPI users younger than 40 years (SIR=22.76, 95%CI 15.94 to 31.52).
- Increased SIRs were found for each indication studied, including those without a relationship with gastric cancer, for example, gastro-oesophageal reflux (SIR=3.04, 95%CI 2.80 to 3.31), and those with a supposedly decreased risk, for example, aspirin users (SIR=1.93, 95%CI 1.70 to 2.18).
- The association was similar for cardia and non-cardia gastric cancer.
- Analyses restricted to adenocarcinoma exhibited similar results to those for all gastric cancers.
- Long-term users of histamine 2 receptor antagonists, which have the same indications as PPIs, were not at any increased risk.