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Proton pump suppression (PPIs) has been warned several times in recent years.
Such as kidney injury, cardiovascular problems, cerebrovascular problems, lung infections, hypomagnesemia, osteoporotic fractures or something.

But no matter how it was previously warned, it is still a stomach medicine.

Now, the study found that even the stomach was sick of it.

BMJ published an article saying that long-term use of PPIs in patients who have completed H. pylori therapy will increase the risk of developing gastric cancer.

This study was done in Hong Kong.

The study included a large sample size of 74,614 patients who completed H. pylori treatment and 142,460 untreated control patients. The total number of patients involved exceeds 200,000. The study was tracked for 10 years.

The researchers stated in the opening that although some studies have pointed out that PPIs are related to the occurrence of gastric cancer, they have not excluded H. pylori and other influencing factors.

Look at the conclusion

What is long-term? What are the results of different frequency of use?

The “GC” in the table is gastric cancer

The data in this table shows that the continuous use of PPIs for more than 1 year, and the daily dose, the risk of cancer compared with non-users, 5.04 times higher. Non-users do not mean to never use PPIs, but use them at a frequency that cannot be used on a weekly basis and will not be used continuously for a long period of time.

The data in the table shows that patients who are taking daily PPIs for more than 2 years are at 6.65 times higher risk of gastric cancer than non-users.

The data in the table shows that the continuous use of PPIs for more than 3 years, the daily taking of the patient’s cancer risk actually can reach as much as 8.34 times!

On average, long-term use of PPIs (more than 1 year) in patients who completed H. pylori therapy had a 2.4-fold higher risk of gastric cancer than non-users. The highest risk is for patients who use daily and for more than three years, up to 8.34 times.

Patients who did not undergo H. pylori therapy but also used PPIs had a risk of developing gastric cancer that was more than 8 times higher than in the treated group.

In addition, in this study, the majority of gastric cancers that were elevated by the risk of PPIs were non-cardia cancers.

What’s the principle?

Related studies suggest that long-term use of PPIs can inhibit gastric acid secretion, increase serum gastrin levels, and promote hyperplasia of oxyntic mucous membranes leading to tumor-like hyperplasia of gastric mucosa.

Then what should we do?

PPIs are not only effective but also have long-lasting effects because of their excellent results.
Daily oral omeprazole 20mg, for 7 consecutive days, the basic pH of gastric acid can be increased from 1.4 to 5.3.
After taking 40 mg once, gastric acid secretion was still partially suppressed after 3 days.
Therefore, it is often one of the first choices for clinical treatment of gastric ulcers and related symptoms.

The relevant guidelines point out that gastric ulcers are chronic diseases and have a long treatment cycle, usually 4-8 weeks.
If the compliance of some patients is not high, the medication time may be extended.
Under controllable circumstances, if PPIs are used for treatment, the treatment course for gastric ulcer should be ended as soon as possible within 8 weeks.

Although the original intention of using PPIs is to treat stomach ailments, long-term use can lead to a drop in gastric acid pH.
Affects digestion, such as nausea, vomiting, bloating, constipation and other symptoms.
In other systems, in addition to the items mentioned at the beginning, there is a problem that if patients have previous depression and anxiety, long-term use of PPIs can cause mental illness such as depression and anxiety to increase.

After completing the treatment of gastric ulcer, if the doctor wants to continue to prescribe medicine to consolidate the therapeutic effect and prevent ulcer recurrence, do not open PPIs again.
Should choose H2RA (H2 receptor blocker), such as cimetidine, famotidine, ranitidine and so on.

This study of BMJ also mentioned that patients with H2RA but not PPIs had a reduced cancer risk of 0.72 after adjusting for the propensity score.

Therefore, reducing the duration of using PPIs and choosing alternative drugs are all appropriate clinical strategies.

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