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Long-term proton pump inhibitor usage and the association with pancreatic cancer in Sweden.

Authors
  • Brusselaers, Nele1, 2, 3
  • Sadr-Azodi, Omid4, 5
  • Engstrand, Lars6, 7
  • 1 Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Visionsgatan 4, 171 64, Stockholm, Sweden. [email protected] , (Sweden)
  • 2 Science for Life Laboratory (SciLifeLab), Stockholm, Sweden. [email protected] , (Sweden)
  • 3 Department of Head and Skin, Faculty of Medicine, Ghent University, Ghent, Belgium. [email protected] , (Belgium)
  • 4 Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. , (Sweden)
  • 5 Department of Surgery, St Göran Hospital, Stockholm, Sweden. , (Sweden)
  • 6 Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Visionsgatan 4, 171 64, Stockholm, Sweden. , (Sweden)
  • 7 Science for Life Laboratory (SciLifeLab), Stockholm, Sweden. , (Sweden)
Type
Published Article
Journal
Journal of gastroenterology
Publication Date
Dec 06, 2019
Identifiers
DOI: 10.1007/s00535-019-01652-z
PMID: 31811561
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The long-term safety of proton pump inhibitors (PPIs) is increasingly questioned. The aim of our study was to assess the risk of pancreatic cancer among long-term PPI users in Sweden. This population-based nationwide Swedish cohort study including 796,492 adult long-term PPI users has been used to calculate the standardized incidence rate ratios (SIRs) and 95% confidence intervals (CI) for pancreatic cancer, stratifying by indications of use, age, sex, and duration of use. The risk among all 20,210 long-term H2-receptor antagonist users was assessed as comparison. Pancreatic cancer was found in 1733 long-term PPI users, and 25 H2-receptor antagonist users. For PPI users, the risk of pancreatic cancer was increased overall (SIRs = 2.22; 95% CI 2.12-2.32) and in all subgroup analyses, with the highest risk among PPI-users younger than 40 years (SIR = 8.90, 95% CI 4.26-16.37), and among individuals with a history of Helicobacter pylori (SIR = 2.99, 95% CI 2.54-3.49). After the first year after enrolment (during which PPI use may be because of early symptoms of pancreatic cancer), the risk remained increased over time, with SIR = 1.57 (95% CI 1.38-1.76) after 5 years. No associations were found for H2-receptor antagonists (SIR = 1.02, 95% CI 0.66-1.51). This large study showed an increased risk of pancreatic cancer in long-term users of PPIs in Sweden, in particular among the youngest users.

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