scholarly journals Proton pump inhibitors usage and the risk of cancer

2021 ◽  
Vol 11 (8) ◽  
pp. 342-348
Author(s):  
Hubert Wróblewski ◽  
Aleksandra Zimna
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Field Studies ◽  
Neuroendocrine Neoplasms ◽  
Gastrointestinal Mucosa ◽  
Increased Risk ◽  
Present Information ◽  
Risk Of Cancer ◽  
The Relationship ◽  
Tumors Of The Liver

Introduction and purpose of the work:Proton pump inhibitors are used to reduce gastric acidity by irreversibly inhibiting the hydrogen-potassium ATPase present in the parietal cells of the stomach. These drugs are used more and more often, often not in accordance with the recommendations. There are reports suggesting a relationship between chronic PPI use and the occurrence of cancer. The aim of the study is to present information on the relationship between the use of proton pump inhibitors and the risk of developing cancer.State of knowledge:Recent field studies have shown that there is a significant relationship between PPI use and carcinogenesis. One possible mechanism is related to the sustained release of gastrin in large amounts, which in turn stimulates the production of substances with trophic effects on the gastrointestinal mucosa, and cell proliferation over time may lead to cancer formation. The relationship between high gastrin concentration and the formation of gastric neuroendocrine neoplasms, tumors of the liver, pancreas and esophagus has been proven.Summary:Proton pump inhibitors are considered safe drugs. Taking into account the described reports on the increased risk of developing certain cancers, when prescribing PPIs, the risk associated with their use should also be taken into account. However, it seems that the benefits of using these drugs outweigh the risks in most cases.

scholarly journals Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching

Gut ◽  
2020 ◽  
Vol 70 (1) ◽  
pp. 76-84 ◽  
Author(s):  
Seung Won Lee ◽  
Eun Kyo Ha ◽  
Abdullah Özgür Yeniova ◽  
Sung Yong Moon ◽  
So Young Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Infection Rates ◽  
Entire Cohort ◽  
Increased Risk ◽  
The Relationship

ObjectiveThe adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing.DesignData were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death).ResultsIn the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.ConclusionPatients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit–risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.

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.

scholarly journals Association of proton pump inhibitors and concomitant drugs with risk of acute kidney injury: a nested case–control study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041543
Author(s):  
Keiko Ikuta ◽  
Shunsaku Nakagawa ◽  
Kenji Momo ◽  
Atsushi Yonezawa ◽  
Kotaro Itohara ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Case Control Study ◽  
Kidney Injury ◽  
Case Control ◽  
Renal Diseases ◽  
Increased Risk ◽  
Nested Case Control ◽  
Control Study

ObjectivesThis study aimed to assess whether the combined use of proton pump inhibitors (PPIs) with non-steroidal anti-inflammatory drugs (NSAIDs) or antibiotics (penicillins, macrolides, cephalosporins or fluoroquinolones) was associated with an increased risk of acute kidney injury (AKI).DesignA nested case–control study.SettingA health insurance claims database constructed by the Japan Medical Data Center.ParticipantsPatients were eligible if they were prescribed a PPI, NSAID and antibiotic at least once between January 2005 and June 2017. The patients who were new PPI users and did not have any history of renal diseases before cohort entry were included (n=219 082). The mean age was 45 and 44% were women.InterventionsCurrent use of PPIs, NSAIDs, or antibiotics.Primary outcome measuresAcute kidney injury.ResultsDuring a mean follow-up of 2.4 (SD, 1.7) years, 317 cases of AKI were identified (incidence rate of 6.1/10 000 person-years). The current use of PPIs was associated with a higher risk of AKI compared with past PPI use (unadjusted OR, 4.09; 95% CI, 3.09 to 5.44). The unadjusted ORs of AKI for the current use of PPIs with NSAIDs, cephalosporins and fluoroquinolones, compared with the current use of PPIs alone, were 3.92 (95% CI, 2.40 to 6.52), 2.57 (1.43 to 4.62) and 3.08 (1.50 to 6.38), respectively. The effects of concurrent use of PPIs with NSAIDs, cephalosporins or fluoroquinolones remain significant in the adjusted model. The analyses on absolute risk of AKI confirmed the results from the nested case–control study.ConclusionsConcomitant use of NSAIDs with PPIs significantly increased the risk for AKI. Moreover, the results suggested that concomitant use of cephalosporins or fluoroquinolones with PPIs was associated with increased risk of incident AKI.

scholarly journals Iatrogenic hypomagnesemia: an underestimated clinical problem

2015 ◽  
Vol 9 (3) ◽  
pp. 287 ◽  
Author(s):  
Antonio Villa ◽  
Paolo Zanada ◽  
Adriana Pellegrino ◽  
Gabriella Nucera ◽  
Elena Martinoli ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Serum Magnesium ◽  
Concomitant Administration ◽  
Clinical Problem ◽  
Proton Pump Inhibitor Therapy ◽  
Term Therapy ◽  
Long Term Therapy ◽  
The Relationship

Hypomagnesemia is defined by having a serum magnesium level of less than 1.7 mg/dL. The magnesium balance is tightly regulated by the concerted actions of the intestine, bone and kidneys. This balance can be disturbed by a wide variety of drugs. Recently, we observed a case of severe hypomagnesemia caused by proton pump inhibitor therapy. We conducted a retrospective study of an <em>intrahospital population</em> to evaluate the prevalence of hypomagnesemia and the relationship with associated drugs. Among 181 patients with hypomagnesemia only 29 were found to have hypomagnesemia with specific causes, such as chronic diarrhea, vomiting, and so on. In the remaining patients, 120 have taken proton pump inhibitors and/or diuretics and/or metformin. Clinicians should consider proton pump inhibitors as a possible causative agent when investigating hypomagnesemia and they should be especially attentive with patients who take proton pump inhibitors, especially in cases of long-term therapy (≥1 year) and/or concomitant administration of other agents that may lower magnesium levels (<em>e.g</em>., diuretics or metformin).

scholarly journals Long-term use of proton-pump inhibitors and risk of gastric cancer: a review of the current evidence

2019 ◽  
Vol 12 ◽  
pp. 175628481983451 ◽  
Author(s):  
Ka Shing Cheung ◽  
Wai K. Leung
Keyword(s):  
Gastric Cancer ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Randomized Clinical Trials ◽  
Bacterial Overgrowth ◽  
Current Evidence ◽  
Neoplastic Progression ◽  
Increased Risk ◽  
H Pylori

Gastric cancer remains one of the leading cancers in the world with a high mortality, particularly in East Asia. Helicobacter pylori infection accounts for the majority of the noncardia gastric cancers by triggering gastric inflammation and subsequent neoplastic progression. Eradication of H. pylori can reduce, but not totally eliminate, subsequent risk of developing gastric cancer. Proton-pump inhibitors (PPIs) are one of the most widely prescribed medications worldwide. With their profound gastric-acid suppression, there are concerns about a possible carcinogenic role in gastric cancer, due to induced hypergastrinemia, gastric atrophy and bacterial overgrowth in the stomach. While randomized clinical trials to establish causality between long-term PPI use and gastric cancer are lacking, current evidence based on observational studies suggests PPIs are associated with an increased gastric cancer risk. However, opinions on causality remain divergent due to unmeasured and possible residual confounding in various studies. Our recent study has showed that even after H. pylori eradication, long-term PPI use is still associated with an increased risk of gastric cancer by more than twofold. Hence, long-term PPIs should be used judiciously after considering individual’s risk–benefit profile, particularly among those with history of H. pylori infection. Further well-designed prospective studies are warranted to confirm the potential role of PPIs in gastric cancer according to baseline gastric histology and its interaction with other chemopreventive agents like aspirin, statins and metformin.

scholarly journals The Association of New-Onset Atrial Fibrillation and Risk of Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mengxia Zhang ◽  
Lin-ling Li ◽  
Qian-qian Zhao ◽  
Xiao-dong Peng ◽  
Kui Wu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Meta Analysis ◽  
Large Sample Size ◽  
Systematic Analysis ◽  
Incident Cancer ◽  
Increased Risk ◽  
Risk Of Cancer ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background. There are distinct results for the relationship between new-onset atrial fibrillation (NOAF) and subsequent incident cancer. To date, no systematic analysis has been conducted on this issue. This study aims to explore the relationship between NOAF and the risk of developing cancer through a meta-analysis with a large sample size. Methods. Electronic databases, such as PubMed and EMBASE, were searched for published relevant studies on NOAF patients diagnosed with cancer after and during follow-ups, including reported records of baseline information and the statistical result of morbidity. Two investigators independently reviewed the articles and extracted the data using uniform standards and definitions. The meta-analysis was conducted using the Cochrane Program Review Manager. Results. This meta-analysis consisted of five cohort studies and one case-control study, which comprised 533,514 participants. The pooled relative risk (RR) for incident cancer was 1.24 (95% CI: 1.10–1.39, P=0.0003). The temporal trend analysis demonstrated that an increased risk of cancer was observed during the initial 90 days (RR: 3.44, 95% CI: 2.29–5.57, P<0.00001), but not after that. Lung cancer (RR: 1.51, 95% CI: 1.47–1.55, P<0.00001) was associated with NOAF, but not colorectal cancer and breast cancer. Conclusion. This meta-analysis provides evidence that NOAF is associated with increased risk of cancer. The risk of incident cancer particularly increases within 90 days after NOAF diagnosis, but not after that.

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