Proton pump inhibitors and risk of colorectal cancer

Gut ◽  
2021 ◽  
pp. gutjnl-2021-325096
Author(s):  
Devin Abrahami ◽  
Emily Gibson McDonald ◽  
Mireille E Schnitzer ◽  
Alan N Barkun ◽  
Samy Suissa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cumulative Dose ◽  
Treatment Initiation ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
Cumulative Duration ◽  
Number Needed To Harm

ObjectiveTo determine whether proton pump inhibitors (PPIs) are associated with an increased risk of colorectal cancer, compared with histamine-2 receptor antagonists (H2RAs).DesignThe United Kingdom Clinical Practice Research Datalink was used to identify initiators of PPIs and H2RA from 1990 to 2018, with follow-up until 2019. Cox proportional hazards models were fit to estimate marginal HRs and 95% CIs of colorectal cancer. The models were weighted using standardised mortality ratio weights using calendar time-specific propensity scores. Prespecified secondary analyses assessed associations with cumulative duration, cumulative dose and time since treatment initiation. The number needed to harm was calculated at five and 10 years of follow-up.ResultsThe cohort included 1 293 749 and 292 387 initiators of PPIs and H2RAs, respectively, followed for a median duration of 4.9 years. While the use of PPIs was not associated with an overall increased risk of colorectal cancer (HR: 1.02, 95% CI 0.92 to 1.14), HRs increased with cumulative duration of PPI use (<2 years, HR: 0.93, 95% CI 0.83 to 1.04; 2–4 years, HR: 1.45, 95% CI 1.28 to 1.60; ≥4 years, HR: 1.60, 95% CI 1.42 to 1.80). Similar patterns were observed with cumulative dose and time since treatment initiation. The number needed to harm was 5343 and 792 for five and 10 years of follow-up, respectively.ConclusionWhile any use of PPIs was not associated with an increased risk of colorectal cancer compared with H2RAs, prolonged use may be associated with a modest increased risk of this malignancy.

Proton pump inhibitors and risk of gastric cancer: population-based cohort study

Gut ◽  
2021 ◽  
pp. gutjnl-2021-325097
Author(s):  
Devin Abrahami ◽  
Emily Gibson McDonald ◽  
Mireille E Schnitzer ◽  
Alan N Barkun ◽  
Samy Suissa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Treatment Initiation ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
Number Needed To Harm

ObjectiveTo determine whether new users of proton pump inhibitors (PPIs) are at an increased risk of gastric cancer compared with new users of histamine-2 receptor antagonists (H2RAs).DesignUsing the UK Clinical Practice Research Datalink, we conducted a population-based cohort study using a new-user active comparator design. From 1 January 1990 to 30 April 2018, we identified 973 281 new users of PPIs and 193 306 new users of H2RAs. Cox proportional hazards models were fit to estimate HRs and 95% CIs of gastric cancer, and the number needed to harm was estimated using the Kaplan-Meier method. The models were weighted using standardised mortality ratio weights using calendar time-specific propensity scores. Secondary analyses assessed duration and dose–response associations.ResultsAfter a median follow-up of 5.0 years, the use of PPIs was associated with a 45% increased risk of gastric cancer compared with the use of H2RAs (HR 1.45, 95% CI 1.06 to 1.98). The number needed to harm was 2121 and 1191 for five and 10 years after treatment initiation, respectively. The HRs increased with cumulative duration, cumulative omeprazole equivalents and time since treatment initiation. The results were consistent across several sensitivity analyses.ConclusionThe findings of this large population-based cohort study indicate that the use of PPIs is associated with an increased risk of gastric cancer compared with the use of H2RAs, although the absolute risk remains low.

scholarly journals Proton pump inhibitors are not associated with an increased risk of colorectal cancer

GastroHep ◽  
2020 ◽  
Vol 2 (4) ◽  
pp. 165-170
Author(s):  
Josephina G. Kuiper ◽  
Myrthe P. P. Herk‐Sukel ◽  
Valery E. P. P. Lemmens ◽  
Ernst J. Kuipers ◽  
Ron M. C. Herings
Keyword(s):  
Colorectal Cancer ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Increased Risk

scholarly journals The risk of community-acquired pneumonia in children using gastric acid suppressants

2021 ◽  
pp. 2003229
Author(s):  
Linda J.T.M. van der Sande ◽  
Quirijn Jöbsis ◽  
Michiel A.G.E. Bannier ◽  
Ewoudt M.W. van de Garde ◽  
Jan J.M. Coremans ◽  
...  
Keyword(s):  
Respiratory Disease ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Proportional Hazards ◽  
Community Acquired Pneumonia ◽  
Cox Proportional Hazards ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Receptor Antagonists ◽  
Increased Risk

With the increased use of acid suppressants, significant potential complications, such as community-acquired pneumonia are becoming more apparent. Paradoxically, in spite of an increased focus on potential complications, there is an increased use of acid suppressants in children and a lack of data specifically targeting the association between acid suppressants and community-acquired pneumonia. Our main objective was to evaluate the risk of community-acquired pneumonia in children using acid suppressants (proton pump inhibitors and/or histamine-2-receptor antagonists).We performed a cohort study using data from the Clinical Practice Research Datalink. All patients aged 1 month to 18 years with a prescription of acid suppressants were included and matched to up to 4 unexposed children. Time-varying Cox proportional hazards models were used to estimate the risk of community-acquired pneumonia. The cohort consisted of 84 868 exposed and 325 329 unexposed children.Current use of proton pump inhibitors and histamine-2-receptor antagonists was associated with an increased risk of community acquired pneumonia, adjusted hazard ratio 2.05 (95% CI 1.90 to 2.22) and 1.80 (95% CI 1.67 to 1.94), respectively. The risk was even greater in patients with respiratory disease. Long term use >211 days of proton pump inhibitors and histamine-2-receptor antagonists led to a significantly greater risk of community-acquired pneumonia compared to short term use <31 days. After cessation of therapy, the risk remained increased for the following 7 months.The use of acid suppressants in children was associated with a doubled risk of community-acquired pneumonia. This risk increased with chronic use, respiratory disease and remained increased after discontinuation of therapy.

scholarly journals Concomitant use of oral glucocorticoids and proton pump inhibitors and risk of osteoporotic fractures among patients with rheumatoid arthritis: a population-based cohort study

2020 ◽  
pp. annrheumdis-2020-218758
Author(s):  
Shahab Abtahi ◽  
Johanna H M Driessen ◽  
Andrea M Burden ◽  
Patrick C Souverein ◽  
Joop P van den Bergh ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Fracture Risk ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Osteoporotic Fractures ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Increased Risk ◽  
Oral Glucocorticoids

BackgroundPatients with rheumatoid arthritis (RA) commonly use oral glucocorticoids (GCs) and proton pump inhibitors (PPIs), both associated with osteoporotic fractures. We investigated the association between concomitant use of oral GCs and PPIs and the risk of osteoporotic fractures among patients with RA.MethodsThis was a cohort study including patients with RA aged 50+ years from the Clinical Practice Research Datalink between 1997 and 2017. Exposure to oral GCs and PPIs was stratified by the most recent prescription as current use (<6 months), recent use (7–12 months) and past use (>1 year); average daily and cumulative dose; and duration of use. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus, forearm, pelvis and ribs) was estimated by time-dependent Cox proportional-hazards models, statistically adjusted for lifestyle parameters, comorbidities and comedications.ResultsAmong 12 351 patients with RA (mean age of 68 years, 69% women), 1411 osteoporotic fractures occurred. Concomitant current use of oral GCs and PPIs was associated with a 1.6-fold increased risk of osteoporotic fractures compared with non-use (adjusted HR: 1.60, 95% CI: 1.35 to 1.89). This was statistically different from a 1.2-fold increased osteoporotic fracture risk associated with oral GC or PPI use alone. Most individual fracture sites were significantly associated with concomitant use of oral GCs and PPIs. Among concomitant users, fracture risk did not increase with higher daily dose or duration of PPI use.ConclusionsThere was an interaction in the risk of osteoporotic fractures with concomitant use of oral GCs and PPIs. Fracture risk assessment could be considered when a patient with RA is co-prescribed oral GCs and PPIs.

Regular use of proton pump inhibitors and risk of type 2 diabetes: results from three prospective cohort studies

Gut ◽  
2020 ◽  
pp. gutjnl-2020-322557 ◽  
Author(s):  
Jinqiu Yuan ◽  
Qiangsheng He ◽  
Long H Nguyen ◽  
Martin C S Wong ◽  
Junjie Huang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Controlled Trial ◽  
Health Study ◽  
Increased Risk ◽  
Randomised Controlled ◽  
Incident Cases

ObjectiveThe association between the regular use of proton pump inhibitors (PPIs) and the risk of type 2 diabetes remains unclear, although a recent randomised controlled trial showed a trend towards increased risk. This study was undertaken to evaluate the regular use of PPIs and risk of type 2 diabetes.MethodThis is a prospective analysis of 204 689 participants free of diabetes in the Nurses' Health Study (NHS), NHS II and Health Professionals Follow-up Study (HPFS). Type 2 diabetes was confirmed using American Diabetes Association (ADA) diagnostic criteria. We evaluated hazard ratios (HRs) adjusting for demographic factors, lifestyle habits, the presence of comorbidities, use of other medications and clinical indications.ResultsWe documented 10 105 incident cases of diabetes over 2 127 471 person-years of follow-up. Regular PPI users had a 24% higher risk of diabetes than non-users (HR 1.24, 95% CI 1.17 to 1.31). The risk of diabetes increased with duration of PPI use. Fully adjusted HRs were 1.05 (95% CI 0.93 to 1.19) for participants who used PPIs for >0–2 years and 1.26 (95% CI 1.18 to 1.35) for participants who used PPIs for >2 years compared with non-users.ConclusionsRegular use of PPIs was associated with a higher risk of type 2 diabetes and the risk increased with longer duration of use. Physicians should therefore exercise caution when prescribing PPIs, particularly for long-term use.

Risk of cerebrovascular disease associated with the use of glucocorticoids in patients with incident rheumatoid arthritis: a population-based study

2011 ◽  
Vol 70 (6) ◽  
pp. 990-995 ◽  
Author(s):  
J Antonio Aviña-Zubieta ◽  
Michal Abrahamowicz ◽  
Hyon K Choi ◽  
M Mushfiqur Rahman ◽  
Marie-Pierre Sylvestre ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cumulative Dose ◽  
Large Population ◽  
Population Based ◽  
Population Based Study ◽  
The Past ◽  
Increased Risk ◽  
Daily Dose ◽  
Cumulative Duration

ObjectivesTo determine the effect of glucocorticoids (GC) on the risk of cerebrovascular accidents (CVA) in patients with rheumatoid arthritis (RA).MethodsA population-based cohort study was carried out using administrative health data on 7051 individuals with RA onset between 1997 and 2001 and no exposure to GC before RA onset. Follow-up was until 2006. GC exposure was defined in four ways: current use (yes/no), current dose (mg/day), cumulative dose (grams) and cumulative duration of use (years). All were used as time-dependent variables updated monthly. CVA were ascertained using hospitalisation and vital statistics data. Transient ischaemic attacks were not considered as CVA. Cox regression models adjusting for demographics, cardiovascular drug use, propensity scores and RA characteristics were used.ResultsThe mean age of the cohort was 56 years and 66% were women. Over 6 years' mean follow-up (43 355 person-years), 178 incident CVA cases were identified. GC current use was not associated with a significant increase in the risk of CVA (HR=1.41, 95% CI 0.84 to 2.37). Similarly, the models that accounted for daily dose (HR=1.07, 95% CI 0.94 to 1.21 for each 5 mg increase in the daily dose), cumulative duration of use (HR=1.1, 95% CI 0.94 to 1.32 for each year accumulated in the past) and total cumulative dose (HR=1.04, 95% CI 0.99 to 1.08 per gram accumulated in the past) were also not significantly associated with CVA.ConclusionsThis large population-based study indicates that GC use is not associated with an increased risk of CVA in cases with RA.

scholarly journals Concomitant Use of Proton-Pump Inhibitors and Clopidogrel Increases the Risk of Adverse Outcomes in Patients With Ischemic Stroke Carrying Reduced-Function CYP2C19*2

2016 ◽  
Vol 24 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Xingyang Yi ◽  
Zhao Han ◽  
Qiang Zhou ◽  
Wen Cheng ◽  
Jing Lin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Primary Outcome ◽  
Adverse Outcomes ◽  
Safety Outcome ◽  
Vascular Death ◽  
Increased Risk ◽  
Significant Difference

Objective: Conflicting data exist as to whether proton-pump inhibitors (PPIs) diminish the efficacy of clopidogrel. The aim of this study was to investigate the association between cytochrome P450 ( CYP) genetic variants and clinical adverse outcomes of concomitant use of PPIs and clopidogrel by patients. Methods: We consecutively enrolled 523 patients with ischemic stroke receiving clopidogrel. Platelet aggregation was measured before and after 7 to 10 days of clopidogrel treatment. Single-nucleotide polymorphisms of CYP3A4, CYP3A5, CYP2C19*2, and CYP2C19*3 were examined using mass spectrometry. The primary outcome was a composite of recurrent ischemic stroke (RIS), myocardial infarction (MI), and vascular death that occurred during the 1-year follow-up period. The safety outcome was hemorrhagic episodes that occurred during the 1-year follow-up period. Results: This study comprised a total of 523 patients with IS, 96.3% (155/161) patients treated with PPIs and 95.9% (347/362) in patients treated without PPIs completed 1-year follow-up. The primary outcome was observed in 69 (13.7%) patients (56 RIS, 7 MI, and 6 died). There was no significant difference in the frequencies of primary outcome and safety outcome between patients treated with or without PPIs. The frequency of primary outcome was significantly higher in patients carrying CYP2C19*2 AG/AA genotype receiving PPIs compared with the same genotype in those not receiving PPIs. The PPIs used in patients carrying CYP2C19*2 AG/AA was independently associated with the primary outcome after adjusting for other risk factors. Conclusions: The concomitant use of PPIs and clopidogrel may be associated with an increased risk of RIS, MI, or vascular death in patients with IS carrying reduced-function CYP2C19*2.

Use of proton pump inhibitors correlates with increased risk of colorectal cancer in Taiwan

2013 ◽  
Vol 9 (2) ◽  
pp. 192-193 ◽  
Author(s):  
Shih-Wei Lai ◽  
Kuan-Fu Liao ◽  
Hsueh-Chou Lai ◽  
Cheng-Li Lin ◽  
Fung-Chang Sung
Keyword(s):  
Colorectal Cancer ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Increased Risk

scholarly journals Intermittent concurrent use of clopidogrel and proton pump inhibitors did not increase risk of adverse clinical outcomes in Chinese patients with coronary artery disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wanbing He ◽  
Xiaorong Shu ◽  
Enyi Zhu ◽  
Bingqing Deng ◽  
Yongqing Lin ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cox Regression ◽  
Asian Population ◽  
Chinese Patients ◽  
Clinical Event ◽  
Cardiac Events ◽  
Concurrent Use ◽  
Increased Risk

Abstract Background Proton pump inhibitors (PPIs) are frequently prescribed to patients with coronary heart disease (CHD) under antiplatelet therapy to prevent gastrointestinal (GI) bleeding. However, its clinical impact is still under debate, especially in Asian population. This study was undertaken to explore the effects of concurrent use of clopidogrel and PPIs on the clinical outcomes in Chinese patients with CHD in secondary prevention. Methods A single-center retrospective study was conducted in 638 patients with CHD on consecutive clopidogrel therapy for at least 1 year. After 18-month follow-up, adverse clinical events were collected. Cox regression was used to calculate hazard ratios (HR) and 95% confidence interval (CI) for the effect of PPI use on the outcomes. A total of 638 patients were recruited from 2014 to 2015 in this study, among whom 201 were sustained PPI users, 188 were intermittent PPI users and the remaining 249 were non-PPI users. Results Compared with sustained PPI users, intermittent use of PPIs was associated with a lower risk of stroke, major adverse cardiac events (MACE) and net adverse clinical event (NACE) (stroke: adjusted HR: 0.109, 95% CI 0.014–0.878, p = 0.037; MACE: adjusted HR: 0.293, 95% CI 0.119–0.722; p = 0.008; NACE: adjusted HR: 0.357, 95% CI 0.162–0.786, p = 0.011). Subgroup analysis further revealed the benefit of intermittent PPI use was significant in male CHD patients over 60 years old, with hypertension or chronic kidney disease, and undergoing percutaneous coronary intervention during hospitalization. Conclusion The current findings suggest that the intermittent concurrent use of PPIs and clopidogrel is not associated with an increased risk of 18-month adverse clinical outcomes, and intermittent use of PPIs is associated with a lower rate of MACE and NACE.

Sign in / Sign up

Export Citation Format

Share Document