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Proton pump inhibitors and gastric cancer: association is not causation
  1. Paul Moayyedi1,
  2. Sander J O Veldhuyzen van Zanten2,
  3. Lawrence Hookey3,
  4. David Armstrong1,
  5. Nicola Jones4,5,6,
  6. Grigorios I Leontiadis1
  1. 1 Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  2. 2 Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
  4. 4 Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
  5. 5 Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
  6. 6 Department of Physiology, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Professor Paul Moayyedi, VP Quality Affairs, Canadian Association of Gastroenterology, McMaster University, Hamilton, ON L8S 4K1, Canada; moayyep{at}

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We read the article by Cheung et al 1 with interest. The research question whether there is a dose-related association between proton pump inhibitors (PPIs) and gastric cancer in a country where this malignancy is highly prevalent is an important one. They report that long-term PPI therapy is associated with an increased risk of gastric cancer in patients who have received Helicobacter pylori eradication therapy. The data suggest that patients taking PPI less than once per day had a lower risk of gastric cancer than did those taking PPIs at least daily, which would support there may be a dose-related response.

There are many concerns that were not adequately addressed in the paper. The paper claims that all the subjects became H. pylori negative as they had all been prescribed eradication therapy and none had received subsequent therapy. However, no data on proof of cure were provided. There …

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  • Contributors All authors conceived the letter and contributed to writing the letter.

  • Competing interests None declared.

  • Patient consent Not required.

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

  • Correction notice This article has been corrected since it was published Online First. The first affiliation has been corrected.