Exercise no. 326 Long-term PPI treatment: increased incidence of gastric cancer and gastric cancer recurrence

Proton pump inhibitors (PPIs) are widely used to treat gastro-esophageal reflux and peptic ulcers. Discontinuation of PPI treatment after several weeks carries a risk of rebound acid hypersecretion, which often causes patients to resume treatment. Prolonged use of a PPI, however, carries a risk of potentially serious adverse effects, including: gastrointestinal infections (including pseudomembranous colitis), and possibly other infections such as pneumonia and listeriosis; bone fractures; and malabsorption of vitamin B12 and hyponatraemia. In 2017, follow-up of a cohort of about 350 000 patients for nearly 6 years showed that all-cause mortality was higher with PPI treatment than with a histamine H2-receptor antagonist, and increased with duration of exposure. In 2018, on the basis of animal studies, Prescrire reported a risk of tumours of the gastric mucosa linked to long-term reduction in gastric acidity. Epidemiological studies had provided contradictory results.