Association between proton pump inhibitor use and gastric cancer: a population-based cohort study using two different types of nationwide databases in Korea

• Published in: Gut Vol. 70; no. 11; p. 2066
• Main Authors: Seo, Seung In, Park, Chan Hyuk, You, Seng Chan, Kim, Jae Young, Lee, Kyung Joo, Kim, Jinseob, Kim, Yerim, Yoo, Jong Jin, Seo, Won-Woo, Lee, Hyung Seok, Shin, Woon Geon
• Format: Journal Article
• Language: English
• Published: England 01-11-2021
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Databases, Factual; Female; Helicobacter Infections - complications; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Incidence; Male; Middle Aged; Propensity Score; Proton Pump Inhibitors - adverse effects; Republic of Korea - epidemiology; Stomach Neoplasms - epidemiology; Republic of Korea; helicobacter pylori; gastric cancer; proton pump inhibition
• ISSN: 1468-3288
• DOI: 10.1136/gutjnl-2020-323845

The association between proton pump inhibitor (PPI) use and gastric cancer related to
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.
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
eradication.
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
-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).
PPI use was associated with gastric cancer, regardless of
eradication status. Long-term PPIs should be used with caution in high-risk regions for gastric cancer.