PPI vs. H²RA Comparison as Potential Risk Factors for Gastric Carcinoma

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Long-term use of PPIs has been suspected to have a provocative effect on gastric cancer and this study was carried out to determine the association between PPI vs. histamine-2 receptor antagonist H²RA use and the risk of gastric cancer in a region where the risk of this malignancy is high.

A population-based cohort study using the Korean National Health Insurance Service database was carried out with participants with first prescription of PPIs and H²RA with normal endoscopy findings from 2004 through 2015 collected. Among them, 50% of participants were systematically stratified and randomly sampled. There were 122,118 users of PPIs or H²RAs who used medication more than cumulative daily defined dose of 180 days. The users were followed up from long-term use threshold until gastric cancer, death from non-gastric cancer cause, gastric surgery, or study end (December 2017). After calculating propensity score weights, 39,799 PPI and 38,967 H²RA users were included. Among the new PPI and H²RA users, 411 cases of incident gastric cancer were identified from 182,643 person/years of followup observation and 397 cases from 178,846 person/years of followup observation, respectively. Compared with H²RA users, PPI users did not experience significantly different gastric cancer incidents (HR 1.01). Sensitivity analyses confirmed that gastric cancer incidence did not differ between PPI and H²RA users.

Shin, G., Park, J., Hong, J., et al.  “Use of Proton Pump Inhibitors vs Histamine 2 Receptor Antagonist for the Risk of Gastric Cancer:  Population-Based Cohort Study.” American Journal of Gastroenterology, 2021; Vol. 116, pp. 1211-1219.

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