5MinuteConsult Journal Club

Chronic PPI Use Associated with Gastric Cancer

References

Gut 2022 Jan; 71:16. (https://doi.org/10.1136/gutjnl-2021-325097)

Am J Gastroenterol. 2012 Mar;107(3):372-8. doi: 10.1038/ajg.2011.420.

Study Summary

This population-based cohort study from January 1990 to 30 April 2018 evaluated if there was a relationship between regular PPI use and the development of gastric cancer. Authors identified 973,281 new users of PPIs and compared them to 193,306 new users of H2Ras.

Outcomes

After a median follow-up of 5.0 years, the use of PPIs was associated with a significant 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 for 5 years of PPI use and 1191 for 10 years.

Conclusion

Chronic PPI use compared to chronic H2RAs can increase odds of gastric cancer development.

Discussion

This association has been known for some time, but this study has a method that is less apt to be prone towards bias. This stands as a further reminder to help wean those on PPIs to H2RAs or off completely if able. Indications for chronic PPI use would include Barrett’s esophagitis or erosive esophagitis, esophageal disease, those with peptic ulcer disease, chronic anti-coagulation with history of PUD (including those on chronic anti-platelet drugs), high risk patients on chronic NSAIDs and for Zollinger Ellison Syndrome.

This study should encourage us to be more aggressive with our counseling for lifestyle changes for GERD. Patient education on not eating before bedtime, smoking cessation, and abdominal breathing (Am J Gastroenterol. 2012 Mar;107(3):372-8. doi: 10.1038/ajg.2011.420.) are safe and effective. It is imperative to follow the AGA guidelines of weaning uncomplicated GERD patients off PPI’s after 6-8 weeks, either to PRN antacids or an H2RA.

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