❑ Meta-analysis of six observational studies providing a comprehensive adjustment for
confounding did not show any association between PPIs and gastric cancer
( RR random =1.07, 0.97−1.19 ; RR fixed =1.05, 0.98−1.12).
❑ Certainty in the random-effect estimate was low (observational studies) but the results
were consistent across sensitivity analyses .
❑ No convincing evidence of a dose-response, or of increased risk with long-term use
was found.
❑ Lack of or minimal adjustment for confounding was associated with larger effect sizes.
Interpretation:
❑ Patients using PPIs did not show a significantly differential risk of gastric cancer as
compared to those using H2RAs when adjustment of confounding was
comprehensive.
❑ The (nonsignificant) absolute increase corresponded to 2 more cases per 10,000
(from 1 less to 6 more) patients.
IMPLICATIONS FOR PRACTICE Our findings are reassuring to all those patients who have an indication for long-term PPI use and need a persistent and effective acid gastric suppression to prevent serious health consequences.
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