RT Journal Article
SR Electronic
T1 Association between proton pump inhibitor use and gastric cancer: a population-based cohort study using two different types of nationwide databases in Korea
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 2066
OP 2075
DO 10.1136/gutjnl-2020-323845
VO 70
IS 11
A1 Seung In Seo
A1 Chan Hyuk Park
A1 Seng Chan You
A1 Jae Young Kim
A1 Kyung Joo Lee
A1 Jinseob Kim
A1 Yerim Kim
A1 Jong Jin Yoo
A1 Won-Woo Seo
A1 Hyung Seok Lee
A1 Woon Geon Shin
YR 2021
UL http://gut.bmj.com/content/70/11/2066.abstract
AB Objective The association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea.Design This study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after 1-year drug exposure, between new users of PPIs and other drugs excluding PPIs, by Cox proportional hazards model. We also analysed the incidence of gastric cancer among PPI users after H. pylori eradication.Results The analysis included 11 741 patients in matched PPI and non-PPI cohorts after large-scale propensity score matching. During a median follow-up of 4.3 years, PPI use was associated with a 2.37-fold increased incidence of gastric cancer (PPI≥30 days vs non-PPI; 118/51 813 person-years vs 40/49 729 person-years; HR 2.37, 95% CI 1.56 to 3.68, p=0.001). The incidence rates of gastric cancer showed an increasing trend parallel to the duration of PPI use. In H. pylori-eradicated subjects, the incidence of gastric cancer was significantly associated with PPI use over 180 days compared with the non-PPI group (PPI≥180 days vs non-PPI; 30/12 470 person-years vs 9/7814 person-years; HR 2.22, 95% CI 1.05 to 4.67, p=0.036).Conclusion PPI use was associated with gastric cancer, regardless of H. pylori eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.Data are available upon reasonable request. The analytic R code is available from the author WGS (e-mail, sgun9139@gmail.com).