Proton pump inhibitors and risk of periampullary cancers--A nested case-control study.
Considerable attention has been focused on long-term use of proton pump inhibitor (PPI) medications in relation to increased risk of cancer via stimulation of DNA-damaged cells. The aim of this study is to examine the dose-dependent effect of PPI on periampullary cancers in a national population-based cohort. A nested case-control analysis was constructed based on Taiwan's National Health Insurance Research Database and the Taiwan Cancer Registry between the years 2000 and 2010. Cases involving patients diagnosed with periampullary cancers were selected and controls were matched to cases according to age, sex and observational period. A "PPI user" was defined as any patient receiving more than 28 cumulative defined daily doses as measured by prescription drug claims. Conditional logistic regression analysis was conducted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) according to the level of PPI exposure. A total of 7,681 cases and 76,762 matched controls were included with a mean follow-up period of 6.6 years (SD: 2.0). The odds of PPI exposure in patients with periampullary cancers were higher than that of control patients with an adjusted OR of 1.35 (95% CIs: 1.16-1.57). Our results also showed that PPI exposure was slightly linked to periampullary cancers in dose-dependent manner. A similar association was observed in patients who solely took PPI but no eradication therapy for Helicobacter pylori infection. Long-term PPI use was associated with an increased risk of periampullary cancers in the current population-based study. Physicians must weigh potential risks of long-term maintenance against therapeutic benefit.
School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
Li-Nien
LN
Chien
Department of General Surgery, Taipei Medical University Hospital, Taipei, Taiwan.|Ph.D. Program for Translational Medicine, Taipei Medical University & Academia Sinica, Taipei, Taiwan.
Yan-Jiun
YJ
Huang
Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan.
Yu-Hsuan Joni
YH
Shao
Department of Gastroenterology, Taipei Medical University Hospital, Taipei, Taiwan.
Chen-Jung
CJ
Chang
School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
Ming-Tsang
MT
Chuang
School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
Hung-Yi
HY
Chiou
Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
Yun
Y
Yen
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012042:Registries; D012306:Risk; D013624:Taiwan / Q000453:epidemiology
D054328:Proton Pump Inhibitors
H. pylori eradication therapy; nested case-control study; periampullary cancers; proton pump inhibitors