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We read with great interest the paper by Cheung et al recently published in your journal.1 The extensive worldwide use of proton pump inhibitors (PPIs) makes the debate about a related risk of gastric cancer a very popular and current topic.2 Potentially, the PPI-induced reduction of acid content in the stomach may contribute to gastric cancer pathogenesis, possibly by increasing gastrin secretion, with a resultant constant trophic stimulus on the gastric mucosa, similar to Helicobacter pylori-related chronic atrophic gastritis.3 These conditions may both feasibly share a similar alteration of the gastric microbiota.4
However, evidence on this topic is not definitive: two meta-analyses of randomised controlled trials found no correlation between gastric cancer and long-term PPI use,5 6 whereas a meta-analysis of observational …
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