Advanced search
1 file | 515.44 KB Add to list

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

(2017) BMJ OPEN. 7(10).
Author
Organization
Abstract
Objective: Proton 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. Design: This 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. Setting: Population-based study in Sweden (2005-2012). Participants: This study included virtually all adults residing in Sweden exposed to maintenance therapy with PPIs. Exposure/Intervention: Maintenance 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 measures: Gastric cancer (cardia and non-cardia), and subgroup analysis for gastric adenocarcinoma, as defined by the Swedish Cancer Registry. Results: Among 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. Conclusions: Long-term PPI use might be an independent risk factor for gastric cancer. This challenges broad maintenance PPI therapy, particularly if the indication is weak.
Keywords
REGISTER, INCREASE, ADULTS, DRUGS

Downloads

  • Brusselaers 2017 PPI gastric cancer.pdf
    • full text
    • |
    • open access
    • |
    • PDF
    • |
    • 515.44 KB

Citation

Please use this url to cite or link to this publication:

MLA
Brusselaers, Nele, Karl Wahlin, Lars Engstrand, et al. “Maintenance Therapy with Proton Pump Inhibitors and Risk of Gastric Cancer : a Nationwide Population-based Cohort Study in Sweden.” BMJ OPEN 7.10 (2017): n. pag. Print.
APA
Brusselaers, N., Wahlin, K., Engstrand, L., & Lagergren, J. (2017). Maintenance therapy with proton pump inhibitors and risk of gastric cancer : a nationwide population-based cohort study in Sweden. BMJ OPEN, 7(10).
Chicago author-date
Brusselaers, Nele, Karl Wahlin, Lars Engstrand, and Jesper Lagergren. 2017. “Maintenance Therapy with Proton Pump Inhibitors and Risk of Gastric Cancer : a Nationwide Population-based Cohort Study in Sweden.” Bmj Open 7 (10).
Chicago author-date (all authors)
Brusselaers, Nele, Karl Wahlin, Lars Engstrand, and Jesper Lagergren. 2017. “Maintenance Therapy with Proton Pump Inhibitors and Risk of Gastric Cancer : a Nationwide Population-based Cohort Study in Sweden.” Bmj Open 7 (10).
Vancouver
1.
Brusselaers N, Wahlin K, Engstrand L, Lagergren J. Maintenance therapy with proton pump inhibitors and risk of gastric cancer : a nationwide population-based cohort study in Sweden. BMJ OPEN. 2017;7(10).
IEEE
[1]
N. Brusselaers, K. Wahlin, L. Engstrand, and J. Lagergren, “Maintenance therapy with proton pump inhibitors and risk of gastric cancer : a nationwide population-based cohort study in Sweden,” BMJ OPEN, vol. 7, no. 10, 2017.
@article{8548979,
  abstract     = {Objective: Proton 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. 
Design: This 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. 
Setting: Population-based study in Sweden (2005-2012). 
Participants: This study included virtually all adults residing in Sweden exposed to maintenance therapy with PPIs. 
Exposure/Intervention: Maintenance 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 measures: Gastric cancer (cardia and non-cardia), and subgroup analysis for gastric adenocarcinoma, as defined by the Swedish Cancer Registry. 
Results: Among 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. 
Conclusions: Long-term PPI use might be an independent risk factor for gastric cancer. This challenges broad maintenance PPI therapy, particularly if the indication is weak.},
  articleno    = {e017739},
  author       = {Brusselaers, Nele and Wahlin, Karl and Engstrand, Lars and Lagergren, Jesper},
  issn         = {2044-6055},
  journal      = {BMJ OPEN},
  keywords     = {REGISTER,INCREASE,ADULTS,DRUGS},
  language     = {eng},
  number       = {10},
  pages        = {8},
  title        = {Maintenance therapy with proton pump inhibitors and risk of gastric cancer : a nationwide population-based cohort study in Sweden},
  url          = {http://dx.doi.org/10.1136/bmjopen-2017-017739},
  volume       = {7},
  year         = {2017},
}

Altmetric
View in Altmetric
Web of Science
Times cited: