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BSG Position Statement – Proton pump inhibitors (PPIs) and the risk of gastric cancer

Dr Andrew F Goddard & Mr Stephen E Attwood (in collaboration with and on behalf of Gastroduodenal & Oesophageal Sections of BSG)

February 2018

A recent study published in Gut by Cheung et al (1) has demonstrated an association between PPI use and gastric cancer in a population from Hong Kong. This has received considerable press coverage and the BSG has produced this position statement to help both clinicians and patients when considering the risks of using PPIs. NHS Choices have published a summary (2) which makes no clear recommendations.

The study

The study in question assessed patients who were treated for Helicobacter pylori for the development of gastric cancer. 153 cases were detected over 7.6 years with PPI use being associated with a 2.44 (CI 1.42-4.20) fold increased risk. No increased risk was seen with H2-receptor antagonist use and most cancers were detected in the body and antrum (i.e. non-cardia cancers).

The study initially appears of reasonable quality but there were significant differences between those patients taking PPIs and those not.  Patients in the PPI group were almost 10 years older than those in the non-PPI group on average. This is important as the incidence of gastric cancer is known to increase with age. There is also some debate about how applicable these findings are to the UK population as both gastric cancer and H. pylori eradication (and thus subsequent PPI use) are increasingly rare.