Association between proton-pump inhibitors and the risk of gastric cancer: a systematic review with meta-analysis.

Segna, Daniel; Brusselaers, Nele; Glaus, Damian; Krupka, Niklas; Misselwitz, Benjamin (2021). Association between proton-pump inhibitors and the risk of gastric cancer: a systematic review with meta-analysis. Therapeutic advances in gastroenterology, 14, p. 17562848211051463. Sage 10.1177/17562848211051463

[img]
Preview
Text
10.1177_17562848211051463.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial (CC-BY-NC).

Download (1MB) | Preview

Introduction

The use of proton-pump inhibitors (PPI) may be associated with an increased risk of gastric cancer (GC).

Objective

To review and meta-analyse available literature investigating the association between PPI use and GC risk.

Methods

Two independent reviewers systematically searched Ovid MEDLINE, EMBASE, and Cochrane Library (inception to July 2020) for case-control and cohort studies assessing the association between PPI use and GC according to a predefined protocol in PROSPERO (CRD42018102536). Reviewers independently assessed study quality, extracted data, and meta-analysed available and newly calculated odds ratios (ORs) using a random-effects model, and stratified for GC site (cardia versus non-cardia) and PPI duration (<1 year, 1-3 years, >3 years).

Results

We screened 2,396 records and included five retrospective cohort and eight case-control studies comprising 1,662,881 individuals in our meta-analysis. In random-effect models, we found an increased GC risk in PPI users [OR: 1.94, 95% confidence interval (95% CI): 1.47-2.56] with high statistical heterogeneity (I 2 = 82%) and overall moderate risk of bias. Stratified analyses indicated a significant risk increase in non-cardia (OR: 2.20, 95% CI: 1.44-3.36, I 2 = 77%) with a similar non-significant trend in cardia regions (OR: 1.77, 95% CI: 0.72-4.36, I 2 = 66%). There was no GC increase with longer durations of PPI exposure (<1 year: OR: 2.29, 95% CI: 2.13-2.47, I 2 = 0%; 1-3 years: OR: 1.46, 95% CI: 0.53-4.01, I 2 = 35%; >3 years: OR: 2.08, 95% CI: 0.56-7.77, I 2 = 61%).

Conclusion

We found a twofold increased GC risk among PPI users, but this association does not confirm causation and studies are highly heterogeneous. PPI should only be prescribed when strictly indicated.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Segna, Daniel; Krupka, Niklas and Misselwitz, Benjamin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1756-283X

Publisher:

Sage

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

01 Dec 2021 11:58

Last Modified:

05 Dec 2021 01:46

Publisher DOI:

10.1177/17562848211051463

PubMed ID:

34777575

Uncontrolled Keywords:

meta-analysis proton-pump inhibitors stomach neoplasms systematic review

BORIS DOI:

10.48350/161710

URI:

https://boris.unibe.ch/id/eprint/161710

Actions (login required)

Edit item Edit item
Provide Feedback