PPI use ups gastric cancer risk in H. pylori-infected patients
In patients infected with Helicobacter pylori, long-term use of proton pump inhibitors (PPIs) is associated with an increased risk of gastric cancer (GC) even after treatment for the infection, a recent population-based study has shown.
The research team retrieved clinical information of 63,397 adults (median age at treatment 54.7 years; 46.5 percent male) who had taken at least 7 days of clarithromycin-based triple therapy for H. pylori infection. Those who failed the regimen or had been diagnosed with GC within 12 months of treatment for H. pylori were excluded.
Cox proportional hazards models were used to determine the risk of GC associated with PPI use. Propensity score adjustments were performed to control for differences in background factors.
In the cohort, 0.24 percent (n=153) developed gastric cancer following treatment for H. pylori. Of these cancers, 20.3 percent (n=31) were in the cardia and 62.1 percent (n=95) were in noncardia regions. Sites were unspecified for the remaining 17.6 percent (n=27) of the cases.
Following propensity score adjustment without trimming, PPI users were significantly at a higher risk of gastric cancer (hazard ratio [HR], 2.44; 95 percent CI, 1.42 to 4.20; p=0.002) compared with nonusers. The significant association remained after trimming (HR, 2.14; 1.27 to 3.58; p=0.004).
Multivariable analysis reflected the same elevated risk of GC after H. pylori therapy, with an HR value of 2.19 (1.31 to 3.66; p=0.003).
The difference in absolute risk of gastric cancer between patients who took PPIs and those who did not was 4.29 per 10,000 person-years after propensity score adjustments.