Auburn ADED 7950 - 737128 (10 pages)

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737128



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737128

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10
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Auburn University Main Campus
Course:
Aded 7950 - Dissertation Seminar
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Rapid 12484662 CROSS REF ID 737128 LENDER MDU Health Sciences Library BORROWER AAA Main Library TYPE Article CC CCG JOURNAL TITLE Gut USER JOURNAL TITLE Gut ARTICLE TITLE Long term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori a population based study ARTICLE AUTHOR Cheung Ka Shing VOLUME ISSUE MONTH 10 YEAR 2017 PAGES gutjnl ISSN 0017 5749 OCLC Processed by RapidX 11 3 2017 5 47 50 AM This material may be protected by copyright law Title 17 U S Code Downloaded from http gut bmj com on November 3 2017 Published by group bmj com Gut Online First published on October 31 2017 as 10 1136 gutjnl 2017 314605 GI cancer Original Article Long term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori a population based study Ka Shing Cheung 1 Esther W Chan 2 Angel Y S Wong 2 Lijia Chen 1 Ian C K Wong 2 3 Wai Keung Leung1 1 Department of Medicine The University of Hong Kong Queen Mary Hospital Hong Kong 2 Department of Pharmacology and Pharmacy Centre for Safe Medication Practice and Research The University of Hong Kong Hong Kong 3 UCL School of Pharmacy University College London London UK Correspondence to Dr Wai Keung Leung Department of Medicine Queen Mary Hospital 102 Pokfulam Road Hong Kong waikleung hku h k Received 1 June 2017 Revised 27 August 2017 Accepted 4 September 2017 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 clarithromycinbased 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 nonPPIs 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 Introduction To cite Cheung KS Chan EW Wong AYS et al Gut Published Online First please include Day Month Year doi 10 1136 gutjnl 2017 314605 Gastric cancer is the third leading cause of cancer related mortality in the world 1 Although Helicobacter pylori eradication has been shown to reduce the risk of gastric cancer development by 33 47 2 3 a considerable proportion of these individuals continues to progress to gastric cancer even after eradication of H pylori Apart from baseline gastric histology at the time of eradication 4 data are sparse on other modifiable risks of gastric cancer development particularly on the role of concurrent medications Proton pump inhibitors PPIs have been among the most commonly prescribed medications in Significance of this study What is already known on this subject Although Helicobacter pylori eradication has been shown to reduce the risk of gastric cancer development a considerable proportion of these individuals continues to progress to gastric cancer even after successful eradication of H pylori Previous studies have shown that the risk of gastric cancer was increased by 43 among PPIs users but the major confounding factor H pylori was not adjusted in these analyses and the causal relationship may be biased What are the new findings Long term PPIs use was associated with a 2 4 fold increase in gastric cancer risk in H pylori infected subjects who had received eradication therapy The risk of gastric cancer increases with the dose and duration of PPIs use How might it impact on clinical practice in the foreseeable future Physicians should exercise caution when prescribing long term PPIs to H pylori infected individuals even after successful eradication of H pylori the world since the first PPI became available in the 1980s 5 Although PPIs are generally considered safe recent data have demonstrated various adverse effects associated with long term use of PPIs including bone fracture 6 Clostridium difficile infection 7 pneumonia 8 myocardial infarction and even stroke 9 Apart from the systemic adverse effects there are also concerns on the long term safety profile of PPIs in the stomach The use of PPIs is associated with profound acid suppression which could worsen atrophic gastritis 10 The risk is considerably high among individuals infected with H pylori who are susceptible to the development of corpus atrophy 11 Moreover PPIs stimulate the production of gastrin which is a potent growth factor and hypergastrinemia has been shown to induce hyperplasia of enterochromaffin like cells 11 A recent meta analysis showed that the risk of gastric cancer is increased by 43 Cheung KS et al Gut 2017 0 1 8 doi 10 1136 gutjnl 2017 314605 1 Copyright Article author or their employer 2017 Produced by BMJ Publishing Group Ltd BSG under licence Downloaded from http gut bmj com on November 3 2017 Published by group bmj com GI cancer among PPI users 12 However these studies included both H pylori infected and H pylori negative subjects Although previous short term studies suggested the resolution of corpus atrophy with H pylori eradication therapy in patients with GORD 13 14 it remains uncertain whether the potential risk of PPIs on gastric cancer development could be eliminated by clearance of H pylori This population based study aimed to determine the risk of gastric cancer development among individuals who had received treatment for H pylori with focus on the role of longterm PPIs Methods Data source Data were retrieved from Clinical Data Analysis and Reporting


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