PPI use ups risk of gastrointestinal cancer

Use of proton pump inhibitors (PPI) appears to increase the risk of developing gastrointestinal malignancies such as gastric, pancreatic, colorectal, and liver cancer, a study has shown.

A team of investigators searched the databases of PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP through June 2022 for eligible meta-analyses or systematic reviews. They considered the summary effect size, 95 percent confidence interval (CI), heterogeneity, small study effect, and 95 percent prediction interval in this study.

Finally, methodological quality and evidence were evaluated using the Measurement Tool to Assess Systematic Review 2 and grading of recommendation, assessment, development, and evaluation.

Twenty-one meta-analyses involving 65 studies and 10 cancer types, with 6.8 million participants, were included in this umbrella review.

Pooled results revealed that PPI use significantly contributed to the increased risks of several cancer types, including gastric (odds ratio [OR], 2.07, 95 percent CI, 1.30‒3.29), pancreatic (OR, 1.73, 95 percent CI, 1.23‒2.44), colorectal (OR, 1.84, 95 percent CI, 1.26‒2.67), and liver (OR, 1.80, 95 percent CI, 1.27‒2.54), but not oesophageal.

On the other hand, PPI use was associated with a lower risk of breast cancer (OR, 0.69, 95 percent CI, 0.50‒0.96).

“These findings suggested that clinicians should pay more attention to the occurrence of gastric cancer, pancreatic cancer, colorectal cancer, and liver cancer in patients who used PPIs, and PPI prescription should be written only when an accurate specific diagnosis has been made,” the investigators said.

“Furthermore, additional PPIs to the treatment regimen may be benefit for women with a higher-than-average risk of breast cancer,” they added.