Proton-Pump Inhibitor Use and Gastric Cancer

A link between long-term proton-pump inhibitor (PPI) use and gastric cancer has been suggested because elevation of serum gastrin levels is associated with PPI use. To date, evidence to support this link has come from observational studies with methodologic limitations. In this retrospective study, investigators used a large U.K. database and a novel active-comparator design to compare 973,000 new users of PPIs and 198,000 new users of histamine-2–receptor antagonists (H₂RAs). Both groups were followed for a median 5 years.

In adjusted analyses that included propensity scoring to limit confounding, new PPI users were significantly more likely than new H₂RA users to develop new gastric cancer (hazard ratio, 1.45); the number needed to harm wa…