Long term use of anti-acid drugs may not increase stomach cancer risk
Long-term use of proton pump inhibitor medication does not appear to be associated with an increased risk of stomach cancer, an analysis has concluded.
Fears that use of the drugs could lead to stomach cancer have been ongoing for decades, the researchers noted in the BMJ but a randomised controlled trial would not be feasible.
Three recent studies had found as much as a two-fold increased risk but they were hampered by ‘methodological limitations’ making the true picture unclear.
Using healthcare data from five Nordic countries over a 26-year period, the Swedish researchers compared more than 17,000 cases of stomach cancer with 172,000 controls.
The study from patients in Denmark, Finland, Iceland, Norway, and Sweden looked at use of PPIs for more than a year as well as histamine-2-receptor antagonists (H2RAs).
They carefully excluded medication use from the 12 months before the stomach cancer diagnosis date or study inclusion date for the control group to prevent the reporting of a potentially false association, the team explained.
And other confounding factors were accounted for including age, sex, Helicobacter pylori eradication treatment, peptic ulcer disease, smoking and alcohol related diseases, obesity or type 2 diabetes, and some other medications, they added.
When all this was taken into account, there was no remaining association between long term use of PPIs or H2RAs and increased risk of stomach cancer.
The team at the Karolinska Institute in Sweden said the previous studies could have been skewed by including PPI use shortly before diagnosis, focusing on short-term prescribing, or failing to account for other variables.
‘The results of this study do not support the hypothesis that long term proton pump inhibitor use is associated with an increased risk of gastric adenocarcinoma.
‘This finding should offer relief for patients needing long term proton pump inhibitor therapy and is valuable for healthcare in clinical decision making,’ they said.
But they did add that long term PPI use might cause side effects and increase the risk of some other potentially serious conditions ‘such as Clostridium difficile associated diarrhoea, osteoporosis, and vitamin or electrolyte malabsorption’.
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