PPIs contribute to small increase in pancreatic cancer risk

Individuals exposed to high cumulative doses of proton pump inhibitors (PPIs) have a slightly elevated risk of pancreatic cancer, a study reports.

Using data from the French National Health Data System, the study included 23,321 patients with pancreatic cancer (mean age 69.8 years, 51.7 percent men) and 75,937 noncancer controls matched according to birth, sex, frequency of hospitalization within 8 years prior to index date, and department of residence.

Compared with controls, patients were more likely to have diabetes mellitus, tobacco- and alcohol-related diseases or drug use, morbid obesity, history of acute or chronic pancreatitis, as well as present with other comorbidities such as chronic obstructive pulmonary disease. In the patient group, pancreatic cancers were most often localized to the head of the pancreas, and 52.3 percent of patients died within 1 year after the index date.

PPI use was documented in 18,141 patients (77.8 percent) and 57,307 controls (75.5 percent), with 43.9 percent and 37.9 percent redeeming prescriptions for ≥181 cumulative defined daily dose (cDDD), respectively. The mean PPI exposure was 658.3 cDDD in the patient group and 560.8 cDDD in the control group. Omeprazole was the most common PPI (50.8 percent and 47.9 percent, respectively), followed by esomeprazole (46.0 percent and 40.6 percent, respectively).

Multivariable conditional logistic regression models revealed that ever PPI use conferred an increased risk of pancreatic cancer compared with nonuse (adjusted odds ratio [aOR], 1.05, 95 percent confidence interval [CI], 1.01–1.09). A dose–response relationship emerged, indicating greater risk increase with higher exposure (1–30 cDDD: aOR, 0.92, 95 percent CI, 0.87–0.97; 31–180 cDDD: aOR, 1.05, 95 percent CI, 1.00–1.11; 181–1,080 cDDD: aOR, 1.18, 95 percent CI, 1.12–1.24; >1,080 cDDD: aOR, 1.17, 95 percent CI, 1.10–1.23).

The present data highlight the importance of efforts to limit PPI treatments to appropriate indications and durations given the overuse of these drugs.