PT  - JOURNAL ARTICLE
AU  - Ka Shing Cheung
AU  - Esther W Chan
AU  - Angel Y S Wong
AU  - Lijia Chen
AU  - Ian C K Wong
AU  - Wai Keung Leung
TI  - Long-term proton pump inhibitors and risk of gastric cancer development after treatment for <em>Helicobacter pylori</em>: a population-based study
AID  - 10.1136/gutjnl-2017-314605
DP  - 2018 Jan 01
TA  - Gut
PG  - 28--35
VI  - 67
IP  - 1
4099  - http://gut.bmj.com/content/67/1/28.short
4100  - http://gut.bmj.com/content/67/1/28.full
SO  - Gut2018 Jan 01; 67
AB  - Objective Proton pump inhibitors (PPIs) is associated with worsening of gastric atrophy, particularly in Helicobacter pylori (HP)-infected subjects. We determined the association between PPIs use and gastric cancer (GC) among HP-infected subjects who had received HP therapy.Designs This study was based on a territory-wide health database of Hong Kong. We identified adults who had received an outpatient prescription of clarithromycin-based triple therapy between year 2003 and 2012. Patients who failed this regimen, and those diagnosed to have GC within 12 months after HP therapy, or gastric ulcer after therapy were excluded. Prescriptions of PPIs or histamine-2 receptor antagonists (H2RA) started within 6 months before GC were excluded to avoid protopathic bias. We evaluated GC risk with PPIs by Cox proportional hazards model with propensity score adjustment. H2RA was used as a negative control exposure.Result Among the 63 397 eligible subjects, 153 (0.24%) developed GC during a median follow-up of 7.6 years. PPIs use was associated with an increased GC risk (HR 2.44, 95% CI 1.42 to 4.20), while H2RA was not (HR 0.72, 95% CI 0.48 to 1.07). The risk increased with duration of PPIs use (HR 5.04, 95% CI 1.23 to 20.61; 6.65, 95% CI 1.62 to 27.26 and 8.34, 95% CI 2.02 to 34.41 for ≥1 year, ≥2 years and ≥3 years, respectively). The adjusted absolute risk difference for PPIs versus non-PPIs use was 4.29 excess GC (95% CI 1.25 to 9.54) per 10 000 person-years.Conclusion Long-term use of PPIs was still associated with an increased GC risk in subjects even after HP eradication therapy.