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  1. Home
  2. Proton Pump Inhibitors And The Risk Of Gastric Cancer: A Systematic Review, Evidence Synthesis And Life Course Epidemiology Perspective
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  2. Proton Pump Inhibitors And The Risk Of Gastric Cancer: A Systematic Review, Evidence Synthesis And Life Course Epidemiology Perspective

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Proton pump inhibitors and the risk of gastric cancer: a systematic review, evidence synthesis and life course

Nele Brusselaers1,2, Habiba Khodir Kamal3, David Graham4

  • 1Dept. of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden nele.brusselaers@ki.se.

BMJ Open Gastroenterology
|April 19, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

Proton pump inhibitors (PPIs) show a consistent association with increased gastric cancer risk. Cautious use in young populations is recommended due to potential long-term harm and emerging risk trends.

Keywords:
ACID-RELATED DISEASESANTI-REFLUX THERAPYGASTRIC CANCERPROTON PUMP INHIBITION

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Area of Science:

  • Gastroenterology and Oncology
  • Epidemiology of Drug-Induced Neoplasia
  • Public Health and Preventive Medicine

Background:

  • Proton pump inhibitors (PPIs) are widely used, but concerns exist regarding their potential to increase gastric cancer risk.
  • Existing epidemiological evidence requires synthesis to understand the association between PPI use and gastric carcinogenesis.
  • Addressing causality and methodological challenges is crucial for accurate risk assessment.

Purpose of the Study:

  • To systematically review and synthesize epidemiological evidence on the association between PPI use and gastric cancer.
  • To evaluate the strength of evidence and explore potential causal links.
  • To assess risks across different age groups and life-course exposures.

Main Methods:

  • Systematic literature review and evidence synthesis.
  • Inclusion of original studies and meta-analyses from major databases up to October 2024.
  • Life-course assessment and analysis of methodological challenges like reverse causation and confounding.
  • Main Results:

    • Consistent association found between PPI use and increased gastric cancer risk (pooled RRs 1.3-2.9 in 20/21 meta-analyses).
    • Methodological challenges include underpowered trials, reverse causation, confounding, and disentangling effects of *Helicobacter pylori*.
    • Emerging trends show increased gastric cancer risk in young men (<40 years) since the early 2000s, coinciding with PPI and *H. pylori* eradication introduction.

    Conclusions:

    • While PPI-associated gastric cancer risk may be limited in older individuals with valid indications, a more rational use is advocated for younger populations.
    • Potential for heightened risk with PPI exposure during sensitive developmental periods (pregnancy, early life) warrants further investigation.
    • The observed increase in gastric cancer among young men necessitates careful consideration of PPI prescribing practices in this demographic.