MedicalResearch.com Interview with:
Dr. Wai Keung Leung
Professor, Division of Gastroenterology & Hepatology
Department of Medicine
Assistant Dean, LKS Faculty of Medicine
University of Hong Kong
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It remains controversial whether proton pump inhibitors will increase the risk of gastric cancer. Although previous studies have shown a possible increase in risk in patients taking long-term proton pump inhibitors (PPI), these studies are confounded by the presence of H. pylori infection. In this population-based study from Hong Kong, we have determined the risk of gastric cancer development in more than 63,000 H. pylori-infected subjects who had the bacterium eradicated by a course of clarithromycin-based triple therapy and continued to take PPI or H2-receptor antagonist (H2RA).
After adjusting for various baseline differences among those PPI and non-PPI users, we found that the risk of gastric cancer was increased by 2.4-fold in those who used long-term PPI. The risk was in tandem with the frequency and duration of PPIs treatment. The risk increased from 5-fold to 8-fold for more than 1-year and 3-year use of PPI, respectively. Similar increase in risk was not observed among those who took H2RA, a weaker acid suppressive agent.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Our study showed that long-term use of proton pump inhibitors still increased the risk of gastric cancer development despite successful eradication of H. pylori. Hence, clinicians should exercise cautions when prescribing long-term PPI to patients even after eradication of the bacterium. However, the absolute risk increase is about 4 per 10,000 person-year follow up, which should be carefully balanced against the potential benefits of PPIs in some patients who need more potent acid suppression. Also, these findings apply to those with H. pylori infection only.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future studies may also look into the risk of proton pump inhibitors in patients without H. pylori infection as well as the risk-benefit ratio in different groups of patients with various indications for PPIs.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Ka Shing Cheung, Esther W Chan, Angel Y S Wong, Lijia Chen, Ian C K Wong, Wai Keung Leung. Long-term proton pump inhibitors and risk of gastric cancer development after treatment forHelicobacter pylori: a population-based study. Gut, 2017; gutjnl-2017-314605 DOI: 10.1136/gutjnl-2017-314605
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