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PPIs may be linked to fundic gland polyps, gastric cancer
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Use of proton pump inhibitors for at least a year was associated with an increased risk for fundic gland polyps, according to a systematic review and meta-analysis.
The study also showed an association between long-term PPI use and gastric cancer, but investigators said this association could be biased due to the limited number of available studies and possible confounding variables.
“Case reports describing the occurrence of [fundic gland polyps (FGPs)] in chronic PPI users have steadily emerged over time,” the researchers wrote. “However, the association of FGPs with the use of PPIs currently remains a topic of debate and the link between FGPs and the risk of gastric cancer is still unclear.”
To evaluate for these associations, researchers searched for randomized controlled trials and observational studies published through July 2015, and ultimately analyzed data from 12 studies involving more than 87,324 patients. These included one randomized controlled trial that reported the impact of PPI use on gastric polyps, six cohort studies and one case-control study of FGPs, and one cohort study and three case-control studies of gastric cancer.
The researchers found that long-term PPI use was associated with FGPs based on fixed-effects (pooled OR = 1.43; 95% CI, 1.24-1.64) and random-effects models (pooled OR = 2.45; 95% CI, 1.24-4.83). They also observed significant heterogeneity across these studies, as well as “highly significant publication bias.” Because data are currently limited, the clinical significance of this association is unclear, they added.
“The results from the analysis of the subgroups by length of PPI exposure suggest that the risk of FGPs increases with increasing duration of PPI use,” the researchers wrote. “This subgroup analysis suggests that the use of PPI for at least 12 months is a necessary condition for the development of FGPs.”
The investigators also found an association between long-term PPI use and gastric cancer (pooled RR = 1.43; 95% CI, 1.23-1.66), and found no significant heterogeneity across these studies, but did not assess for publication bias. Again, they acknowledged the strength of this association is limited by the small number of studies, their inability to adequately assess publication bias, and the limited consideration of confounders like H. pylori status in these studies.
“Given the large number of patients receiving PPIs, more and higher quality studies are needed to confirm or repudiate any causal link between PPI use and gastric cancer,” they concluded. “In addition, the potential link between PPI-related FGPs and gastric cancer should be studied in more detail.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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