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Proton pump inhibitors and the risk for gastric cancer: possible confounding by serum vitamin B 12
  1. Itai Gueta1,
  2. Hillel Halkin1,2,
  3. Noa Markovits1,2,
  4. Ronen Loebstein1,2
  1. 1 The Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel
  2. 2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
  1. Correspondence to Dr Itai Gueta, Sheba Medical Center, Tel Hashomer, Ramat Gan, 5262000, Israel; itai.gueta{at}

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We read with interest the article by Cheung et al 1 reporting an increased risk of gastric cancer with long-term exposure to proton pump inhibitors (PPI) following Helicobacter pylori (HP) eradication. Several recent reports and a meta-analysis have also demonstrated this association.2 3 The present study, using strict exclusion criteria, was able to adjust for the confounding effect of previous HP infection and eradication, demonstrating a PPI exposure-dependent escalating risk for non-cardia gastric cancer (NCGC) in previously infected patients. The authors suggest that the profound acid suppression by PPIs worsens the atrophic gastritis induced by HP infection, …

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  • Contributors IG and HH raised the conception and performed the literature survey. All authors contributed to the writing of the letter. IG is the guarantor.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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