With H Pylori, High dose of PPIs tied to gastric intestinal metaplasia and cancer: Study

Written By : Dr. Nandita Mohan |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-09-28T11:45:00+05:30 | Updated On 28 Sept 2020 4:16 PM IST

There are multiple factors for gastric intestinal metaplasia.

The researchers conducted a large retrospective study and evaluated whether cumulative proton pump inhibitor dose is associated with the diagnosis of gastric intestinal metaplasia while controlling for multiple variables.

They found that patients positive for Helicobacter pylori (H. pylori), high cumulative proton pump inhibitor (PPI) doses were found to be significantly associated with precancerous gastric intestinal metaplasia (GIM) in a dose-dependent manner.

Emerging evidence from several observational studies suggests that the long-term use of proton pump inhibitors (PPIs) is associated with a higher risk of gastric cancer development, especially in patients who have undergone Helicobacter pylori

The upper quartiles of PPI use were also associated with a five- to 10-fold increased risk for a diagnosis of GIM with low-grade dysplasia reported Yifat Snir, Head of Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel in his recent study published in the United European Journal of Gastroenterology.

"We retrospectively identified 14,147 patients and retrieved data including age, sex, ethnicity, smoking status, Helicobacter pylori status, cumulative proton pump inhibitor issued within 10 years, anti-parietal cell antibodies, body mass index, and comorbidity index for the study", he further added.

The median age for these patients included in the study was 63.4; 54.4% of the patients were women and 96.8% were Jewish Israeli. In addition, 29% of the patients were H. pylori-positive, and of these, 8.8% (1,244 patients) had GIM.

Snir and his colleagues delivered the following outcomes-

Upper quartiles of cumulative proton pump inhibitor doses were associated with the diagnosis of gastric intestinal metaplasia.

Upper quartiles of proton pump inhibitor dose were associated with a 5–10-fold increased risk of low-grade dysplasia

The authors highlighted "Data regarding the effects of long-term PPI use on the development of pre-cancerous gastric lesions such as gastric atrophy and GIM, especially in patients treated for H. pylori infection, are confounding."

Keeping the limitation in view "We report a dose-dependent association of PPI doses with the diagnosis of GIM among patients treated for H. pylori infection but not in H. pylori-negative patients. We also report that the upper quartiles of PPI use were associated with a 5–10-fold increased risk of GIM with LGD," the authors concluded.In patients positive for Helicobacter pylori (H. pylori), upper quartiles of cumulative proton pump inhibitor (PPI) doses were found to be significantly associated with precancerous gastric intestinal metaplasia (GIM) in a dose-dependent manner, a large retrospective study found.

PPIsgastric intestinal metaplasiaHelicobacter pyloriprecancerousUnited European Journal of Gastroenterology

Source : United European Journal of Gastroenterology

Dr. Nandita Mohan

BDS, MDS( Pedodontics and Preventive Dentistry)

Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751