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Long-term proton pump inhibitor use is a risk factor of gastric cancer after treatment for Helicobacter pylori: a retrospective cohort analysis
  1. Ryota Niikura1,
  2. Yoku Hayakawa1,
  3. Yoshihiro Hirata1,
  4. Atsuo Yamada1,
  5. Mitsuhiro Fujishiro1,2,
  6. Kazuhiko Koike1
  1. 1 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2 Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
  1. Correspondence to Dr Yoku Hayakawa, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; hayakawayoku{at}

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We read with interest the recent publication by Cheung et al. The authors conclude that proton pump inhibitor (PPI) use is associated with a 2.4-fold increase in the risk of gastric cancer in patients who received Helicobacter pylori eradication therapy.1 This is an important finding given that the safety of long-term PPI use remains unclear. Notably, no significant association between histamine-2 receptor antagonist (H2RA) use and gastric cancer was observed, which suggests a PPI-specific effect in this context.

Cheung et al used a large population-based database to select patients after eradication and performed propensity score adjustment analysis. However, as the authors described in the Discussion section, we have concerns about the limitations of this study, in particular the lack of endoscopic and histological examinations, the results of which could influence the association between PPI use and gastric cancer. The presence …

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  • Contributors RN and YHa participated in the study design and wrote the manuscript. RN analysed the data. YHi, AY, MF and KK advised on the study design and contributed to manuscript writing.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The institutional review boards at the University of Tokyo.

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