Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysis
Background: Long-term maintenance therapy with proton pump inhibitors (PPIs) is a common treatment strategy for acid-related gastrointestinal diseases. However, concerns have been raised about the potential increased risk of gastric cancer and related precancerous lesions with long-term PPI use. Thi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2023.1244400/full |
| _version_ | 1797737130293723136 |
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| author | Zeyi Zheng Ziyu Lu Yani Song |
| author_facet | Zeyi Zheng Ziyu Lu Yani Song |
| author_sort | Zeyi Zheng |
| collection | DOAJ |
| description | Background: Long-term maintenance therapy with proton pump inhibitors (PPIs) is a common treatment strategy for acid-related gastrointestinal diseases. However, concerns have been raised about the potential increased risk of gastric cancer and related precancerous lesions with long-term PPI use. This systematic review and meta-analysis aimed to evaluate this potential risk.Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomised controlled trials published before 1 March 2023, with no language restrictions. The primary endpoint was the occurrence and progression of gastric mucosal atrophy, intestinal metaplasia, Enterochromaffin-like (ECL) cell hyperplasia, gastric polyps, and gastric cancer during the trial and follow-up. Data were analysed using a random effects model.Results: Of the 4,868 identified studies, 10 met the inclusion criteria and were included in our analysis, comprising 27,283 participants. Compared with other treatments, PPI maintenance therapy for more than 6 months was associated with an increased risk of ECL cell hyperplasia (OR 3.01; 95% CI 1.29 to 7.04; p = 0.01). However, no significant increase was found in the risk of gastric mucosal atrophy (OR 1.01; 95% CI 0.55 to 1.85; p = 0.97), intestinal metaplasia (OR 1.14; 95% CI 0.49 to 2.68; p = 0.76), gastric polyps (OR 1.13; 95% CI 0.68 to 1.89; p = 0.64), or gastric cancer (OR 1.06; 95% CI 0.79 to 1.43; p = 0.71).Conclusion: This systematic review and meta-analysis does not support an increased risk of gastric cancer or related precancerous lesions with long-term PPI maintenance therapy. However, long-term PPI use should be monitored for potential complications such as ECL cell hyperplasia. Further studies are needed to confirm these findings and evaluate the safety of PPI maintenance therapy for acid-related gastrointestinal diseases.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, Identifier: PROSPERO (CRD42022379692). |
| first_indexed | 2024-03-12T13:23:56Z |
| format | Article |
| id | doaj.art-0e1a34673ee140bf91c0cb240f4ed6ea |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-03-12T13:23:56Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-0e1a34673ee140bf91c0cb240f4ed6ea2023-08-25T11:52:15ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122023-08-011410.3389/fphar.2023.12444001244400Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysisZeyi Zheng0Ziyu Lu1Yani Song2School of Traditional Chinese Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia, ChinaSchool of Basic Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia, ChinaSchool of Water Resources and Hydropower Engineering, Wuhan University, Wuhan, Hubei, ChinaBackground: Long-term maintenance therapy with proton pump inhibitors (PPIs) is a common treatment strategy for acid-related gastrointestinal diseases. However, concerns have been raised about the potential increased risk of gastric cancer and related precancerous lesions with long-term PPI use. This systematic review and meta-analysis aimed to evaluate this potential risk.Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomised controlled trials published before 1 March 2023, with no language restrictions. The primary endpoint was the occurrence and progression of gastric mucosal atrophy, intestinal metaplasia, Enterochromaffin-like (ECL) cell hyperplasia, gastric polyps, and gastric cancer during the trial and follow-up. Data were analysed using a random effects model.Results: Of the 4,868 identified studies, 10 met the inclusion criteria and were included in our analysis, comprising 27,283 participants. Compared with other treatments, PPI maintenance therapy for more than 6 months was associated with an increased risk of ECL cell hyperplasia (OR 3.01; 95% CI 1.29 to 7.04; p = 0.01). However, no significant increase was found in the risk of gastric mucosal atrophy (OR 1.01; 95% CI 0.55 to 1.85; p = 0.97), intestinal metaplasia (OR 1.14; 95% CI 0.49 to 2.68; p = 0.76), gastric polyps (OR 1.13; 95% CI 0.68 to 1.89; p = 0.64), or gastric cancer (OR 1.06; 95% CI 0.79 to 1.43; p = 0.71).Conclusion: This systematic review and meta-analysis does not support an increased risk of gastric cancer or related precancerous lesions with long-term PPI maintenance therapy. However, long-term PPI use should be monitored for potential complications such as ECL cell hyperplasia. Further studies are needed to confirm these findings and evaluate the safety of PPI maintenance therapy for acid-related gastrointestinal diseases.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, Identifier: PROSPERO (CRD42022379692).https://www.frontiersin.org/articles/10.3389/fphar.2023.1244400/fullproton pump inhibitorsgastric cancermeta-analysisgastric mucosal atrophyintestinal metaplasiaenterochromaffin-like cell |
| spellingShingle | Zeyi Zheng Ziyu Lu Yani Song Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysis Frontiers in Pharmacology proton pump inhibitors gastric cancer meta-analysis gastric mucosal atrophy intestinal metaplasia enterochromaffin-like cell |
| title | Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysis |
| title_full | Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysis |
| title_fullStr | Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysis |
| title_full_unstemmed | Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysis |
| title_short | Long-term proton pump inhibitors use and its association with premalignant gastric lesions: a systematic review and meta-analysis |
| title_sort | long term proton pump inhibitors use and its association with premalignant gastric lesions a systematic review and meta analysis |
| topic | proton pump inhibitors gastric cancer meta-analysis gastric mucosal atrophy intestinal metaplasia enterochromaffin-like cell |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2023.1244400/full |
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