Systematic review with meta-analysis: fundic gland polyps and proton pump inhibitors

Background: There are controverted whether the long-term use of proton pump inhibitors (PPI) will increase the risk of gastric cancer. We performed a meta-analysis to assess the risk of gastric cancer in PPI users compared with non-PPI users. Methods: The main inclusion criteria were original studies reporting the incidence of gastric cancer in PPI users compared with non-PPI users. Key outcomes were the risk ratios (RR) for gastric cancer in association with PPI users or non-PPI users. Results: We analyzed data from 8 studies, comprising more than 927,684 patients. The risk of gastric cancer in PPI users was significantly higher than in non-PPI users [RR= 2.10, 95% CI (1.17-3.97)]. The risk of gastric cancer was similar between the 2 groups when the duration was ≤1 year [RR= 2.18, 95% CI (0.66-7.11)]. While the risk of gastric cancer for PPI users was higher than in non-PPI users when the duration was between 1-3 years, ≥1 year, ≥3 years and ≥5 years. The risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users [RR= 2.66, 95% CI (1.66 -4.27)], and the risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users when the duration ≥1 year [RR= 1.99, 95% CI (1.03-3.83)], but the risk for cardiac gastric cancer was similar between the 2 groups [RR= 1.86, 95% CI (0.71-4.89)]. Conclusions: We found the long-term use of PPI (duration ≥1 year) was significantly associated with a higher risk of non-cardiac gastric cancer.

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The Association between the Use of Proton Pump Inhibitors and the Risk of Hypomagnesemia: A Systematic Review and Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0112558 ◽

2014 ◽

Vol 9 (11) ◽

pp. e112558 ◽

Cited By ~ 62

Author(s):

Chan Hyuk Park ◽

Eun Hye Kim ◽

Yun Ho Roh ◽

Ha Yan Kim ◽

Sang Kil Lee

Keyword(s):

Systematic Review ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Meta Analysis

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Proton pump inhibitors’ use and risk of hip fracture: a systematic review and meta-analysis

Rheumatology International ◽

10.1007/s00296-018-4142-x ◽

2018 ◽

Vol 38 (11) ◽

pp. 1999-2014 ◽

Cited By ~ 21

Author(s):

Salman Hussain ◽

Ali Nasir Siddiqui ◽

Anwar Habib ◽

Md. Sarfaraj Hussain ◽

Abul Kalam Najmi

Keyword(s):

Systematic Review ◽

Hip Fracture ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Meta Analysis

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Are Proton Pump Inhibitors More Effective Than Histamine-2-Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients? A Systematic Review and Meta-Analysis of Cohort Studies

Annals of Pharmacotherapy ◽

10.1177/10600280211059040 ◽

2021 ◽

pp. 106002802110590

Author(s):

Na He ◽

Yingying Yan ◽

Shan Su ◽

Qinggang Ge ◽

Suodi Zhai

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Critically Ill ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Stress Ulcer ◽

Meta Analysis ◽

Risk Of Bias ◽

Gi Bleeding ◽

Ulcer Prophylaxis

Background: Histamine-2-receptor antagonists (H2RAs) have been largely replaced by proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) despite the inconclusive evidence concerning comparative effectiveness. Objective: To compare the effectiveness of PPIs and H2RAs on SUP in real-world setting. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to September 19, 2021. We included cohort studies comparing PPIs with H2RAs in critically ill adult patients and explicitly reporting the outcome of gastrointestinal (GI) bleeding or mortality. Newcastle-Ottawa Scale was used to assess potential risk of bias. We conducted a random-effects meta-analysis and only the studies with adjusted effect estimates were pooled. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the overall quality of the evidence. Results: Thirteen cohort studies (N = 145 149) were eligible and 11 of them available for full texts were of low to moderate risk of bias. Meta-analysis of adjusted effect estimates indicated that PPIs were associated with a significantly higher risk of GI bleeding, compared with H2RAs (8 studies, odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.30-3.01, low certainty). Post hoc pooling analysis also suggested that PPIs were associated with a slightly higher risk of mortality in comparison with H2RAs (7 studies, OR = 1.27, 95% CI = 1.13-1.42, low certainty). Conclusion and Relevance: The systematic review of cohort studies showed that PPIs were associated with higher risks of GI bleeding and mortality, although the certainty of evidence was low. Overall, we suggest not excluding H2RAs for SUP, while further studies are essential for elucidating the risk stratification, optimal regimen, and specific duration.

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