PPI Use After H. pylori Eradication Therapy Tied to Increased Risk for Gastric Cancer

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Long-term use of proton-pump inhibitors (PPIs) after treatment for Helicobacter pylori infection is associated with increased risk for gastric cancer, according to a study in Gut.

Using a Hong Kong healthcare database, researchers studied over 60,000 adults who received clarithromycin-based triple therapy for H. pylori eradication. About 5% of the cohort was subsequently prescribed a PPI.

During roughly 8 years' follow-up, 0.24% of the cohort was diagnosed with gastric cancer. In adjusted analyses, the gastric cancer risk was more than twice as high in patients who'd used PPIs at least weekly compared with nonusers. This translated to roughly four excess gastric cancer cases per 10,000 person-years. Cancer risk increased with increasing duration of PPI therapy.

The researchers note that the acid-suppressive effects of PPIs could worsen atrophic gastritis. They conclude that clinicians "should exercise caution when prescribing long-term PPIs to H. pylori-infected individuals even after successful eradication of H. pylori."