SNFGE SNFGE
 
Thématique :
- Cancers autres (hors CCR et CHC)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Thomas APARICIO
Coup de coeur :
 
 
Gastroenterology
  2018/01  
 
  2018 Jan;67(1):28-35.  
  doi: 10.1136/gutjnl-2017-314605.  
 
  Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study.  
 
  Cheung KS, Chan EW, Wong AYS, Chen L, Wong ICK, Leung WK  
  https://www.ncbi.nlm.nih.gov/pubmed/29089382  
 
 

Abstract

OBJECTIVE:

Proton pump inhibitors (PPIs) is associated with worsening of gastric atrophy, particularly in Helicobacter pylori (HP)-infected subjects. We determined the association between PPIs use and gastric cancer (GC) among HP-infected subjects who had received HP therapy.

DESIGNS:

This study was based on a territory-wide health database of Hong Kong. We identified adults who had received an outpatient prescription of clarithromycin-based triple therapy between year 2003 and 2012. Patients who failed this regimen, and those diagnosed to have GC within 12 months after HP therapy, or gastric ulcer after therapy were excluded. Prescriptions of PPIs or histamine-2 receptor antagonists (H2RA) started within 6 months before GC were excluded to avoid protopathic bias. We evaluated GC risk with PPIs by Cox proportional hazards model with propensity score adjustment. H2RA was used as a negative control exposure.

RESULT:

Among the 63 397 eligible subjects, 153 (0.24%) developed GC during a median follow-up of 7.6 years. PPIs use was associated with an increased GC risk (HR 2.44, 95% CI 1.42 to 4.20), while H2RA was not (HR 0.72, 95% CI 0.48 to 1.07). The risk increased with duration of PPIs use (HR 5.04, 95% CI 1.23 to 20.61; 6.65, 95% CI 1.62 to 27.26 and 8.34, 95% CI 2.02 to 34.41 for ≥1 year, ≥2 years and ≥3 years, respectively). The adjusted absolute risk difference for PPIs versus non-PPIs use was 4.29 excess GC (95% CI 1.25 to 9.54) per 10 000 person-years.

CONCLUSION:

Long-term use of PPIs was still associated with an increased GC risk in subjects even after HP eradication therapy.

 

 
Question posée
 
Un traitement par IPP au long cours est-il associé à une augmentation du risque de cancer gastrique chez les patients ayant reçu un traitement d’éradication d’Hélicobacter pylori ?
 
Question posée
 
Oui.
 
Commentaires

Grandeur et décadence des IPP. Le gastroentérologue a un rôle central dans la juste prescription de cette classe thérapeutique qui est suspecte de plus en plus d’effets secondaires à long terme.

 
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