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.

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.

scholarly journals Maintenance therapy with proton pump inhibitors and risk of gastric cancer: a nationwide population-based cohort study in Sweden

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017739 ◽  
Author(s):  
Nele Brusselaers ◽  
Karl Wahlin ◽  
Lars Engstrand ◽  
Jesper Lagergren
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Maintenance Therapy ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Age Groups ◽  
Population Based ◽  
Background Population ◽  
Increased Risk

ObjectiveProton pump inhibitors (PPIs) are among the most commonly prescribed drugs. Concerns have been raised about a potentially increased risk of gastric cancer following long-term use. Our aim is to assess the risk of gastric cancer associated with PPI use, taking into account underlying indications.DesignThis is 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.SettingPopulation-based study in Sweden (2005–2012).ParticipantsThis study included virtually all adults residing in Sweden exposed to maintenance therapy with PPIs.Exposure/InterventionMaintenance use of PPIs, defined as at least 180 days during the study period. Maintenance use of histamine 2 receptor antagonist was evaluated for comparison reasons.Outcome measuresGastric cancer (cardia and non-cardia), and subgroup analysis for gastric adenocarcinoma, as defined by the Swedish Cancer Registry.ResultsAmong 797 067 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 especially 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 an association 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 showed 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.ConclusionsLong-term PPI use might be an independent risk factor for gastric cancer. This challenges broad maintenance PPI therapy, particularly if the indication is weak.

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

2009 ◽  
Vol 100 (9) ◽  
pp. 1503-1507 ◽  
Author(s):  
A H Poulsen ◽  
S Christensen ◽  
J K McLaughlin ◽  
R W Thomsen ◽  
H T Sørensen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Population Based

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

Gut ◽  
2021 ◽  
pp. gutjnl-2021-325385
Author(s):  
Jigar Patel ◽  
Ivan Berezowski ◽  
Rajesh Naidu Janapala ◽  
Ali Pourmand
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Population Based

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.

Body mass index and risk of all-cause mortality in normotensive and hypertensive adults: The Rural Chinese Cohort Study

2021 ◽  
pp. 1-25
Author(s):  
Qionggui Zhou ◽  
Xuejiao Liu ◽  
Yang Zhao ◽  
Pei Qin ◽  
Yongcheng Ren ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Normal Weight ◽  
Sensitivity Analyses ◽  
Hypertension Status ◽  
Moderation Effect ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Chinese Cohort ◽  
The Impact

Abstract Objective: The impact of baseline hypertension status on the BMI–mortality association is still unclear. We aimed to examine the moderation effect of hypertension on the BMI–mortality association using a rural Chinese cohort. Design: In this cohort study, we investigated the incident of mortality according to different BMI categories by hypertension status. Setting: Longitudinal population-based cohort Participants: 17,262 adults ≥18 years were recruited from July to August of 2013 and July to August of 2014 from a rural area in China. Results: During a median 6-year follow-up, we recorded 1109 deaths (610 with and 499 without hypertension). In adjusted models, as compared with BMI 22-24 kg/m2, with BMI ≤18, 18-20, 20-22, 24-26, 26-28, 28-30 and >30 kg/m2, the HRs (95% CI) for mortality in normotensive participants were 1.92 (1.23-3.00), 1.44 (1.01-2.05), 1.14 (0.82-1.58), 0.96 (0.70-1.31), 0.96 (0.65-1.43), 1.32 (0.81-2.14), and 1.32 (0.74-2.35) respectively, and in hypertensive participants were 1.85 (1.08-3.17), 1.67 (1.17-2.39), 1.29 (0.95-1.75), 1.20 (0.91-1.58), 1.10 (0.83-1.46), 1.10 (0.80-1.52), and 0.61 (0.40-0.94) respectively. The risk of mortality was lower in individuals with hypertension with overweight or obesity versus normal weight, especially in older hypertensives (≥60 years old). Sensitivity analyses gave consistent results for both normotensive and hypertensive participants. Conclusions: Low BMI was significantly associated with increased risk of all-cause mortality regardless of hypertension status in rural Chinese adults, but high BMI decreased the mortality risk among individuals with hypertension, especially in older hypertensives.

Sign in / Sign up

Export Citation Format

Share Document