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Proton pump inhibitors and the risk for gastric cancer: possible confounding by serum vitamin B12
  1. Itai Gueta1,
  2. Hillel Halkin1,2,
  3. Noa Markovits1,2,
  4. Ronen Loebstein1,2
  1. 1The Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel
  2. 2Sackler 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 al1 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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