2017-11-02 13:07:24 UTC

New PPI Study on Gastric Cancer Generates Media Attention

Nov. 2, 2017

AGA provides talking points to help your patients understand the science behind the PPI study.

The results of a new study about the use of proton pump inhibitors (PPIs) and their link to gastric cancer has been covered by various media outlets. This may cause your patients to question whether they should stay on or start using PPIs. Like all recent PPI studies, the information is important and interesting, but the results should not automatically alter practice, due to the limitations of the study's methodology.
The study, “Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study,” published in Gut, concluded that even after Helicobacter pylori (H. pylori) eradication therapy, long-term use of PPIs was associated with an increased risk of gastric cancer. However, according to Steven Moss, MD, AGAF, professor of medicine, Brown University Medical School, Providence, RI, this study was not a randomized clinical trial, but a retrospective analysis of two unmatched groups (PPI users and non-users), which may not have had comparable precancerous gastric changes; therefore, the conclusions are open to debate. GIs should be careful interpreting non-randomized studies about purported PPI side effects, as we have learned that they are not always corroborated in subsequent investigations.  
When discussing this study with your patients, try the following strategies to help alleviate their concerns.
  1. Be honest. PPI’s, like all drugs, have side effects. GIs are cautious when prescribing long-term PPIs for acid reflux, doing so when the benefits outweigh the risks. Patients may be aware of this and other studies, but you can help contextualize the content and provide your opinion. AGA offers talking points on several recent PPI studies
  2. Start simple. For mild reflux symptoms, patients can first try histamine H2 receptor antagonists and simple antacids, especially in conjunction with lifestyle changes. AGA offers patient education materials on GERD, including lifestyle management, that you can share with your patients.  
  3. Personalize it. For severe and/or frequent acid reflux symptoms, PPIs work best for most patients. The small possible risk of gastric cancer suggested by this limited report must be weighed against the definite benefits of those who suffer with severe reflux symptoms. 
  4. Stay in touch. In patients who remain on long term PPIs, it is good practice to try and reduce the dose on occasion to maintain patients on the lowest dose possible to control their symptoms, since, in general, PPI side effects are related to the total dose. 

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