Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Clin Gastroenterol Hepatol. 2016 Dec;14(12):1706-1719.e5. doi: 10.1016/j.cgh.2016.05.018. Epub 2016 May 20.
BACKGROUND & AIMS: There have been increasing numbers of case reports and observational studies of adverse events in patients receiving long-term therapy with proton pump inhibitors (PPIs). The effects of PPI therapy on risks of fundic gland polyps (FGPs) and gastric cancer have received considerable attention. We performed a systematic review with a meta-analysis of randomized controlled trials and observational studies that assessed these risks.
We searched the PUBMED, EMBASE, and Cochrane Central Register of Controlled Trials databases for relevant studies published through July 2015. We calculated pooled odds ratio for FGPs and the risk ratio for gastric cancer in PPI users compared with PPI nonusers using fixed- and random-effects models.
We analyzed data from 12 studies, comprising more than 87,324 patients: 1 randomized controlled trial reporting the effect of PPIs on gastric polyps (location not specified), 6 cohort and 1 case-control studies on FGPs, and 1 cohort and 3 case-control studies on gastric cancer. Pooled odds ratios for FGPs were 1.43 (95% confidence interval, 1.24-1.64) and 2.45 (95% confidence interval, 1.24-4.83) from fixed- and random-effects models, respectively. The pooled risk ratio for gastric cancer was 1.43 (95% confidence interval, 1.23-1.66) from each model. We observed significant heterogeneity among studies reporting on FGPs, but not among studies reporting on gastric cancer.
Based on a systematic review with meta-analysis, long-term use of PPIs (≥12 months) is associated with an increased risk of FGPs. PPI therapy might also increase the risk of gastric cancer, but this association could be biased, because of the limited number of studies and possible confounding factors.
接受质子泵抑制剂（PPIs）长期治疗的患者发生不良事件的病例报告和观察性研究越来越多。PPI 治疗对胃底腺息肉（FGPs）和胃癌风险的影响受到了广泛关注。我们对评估这些风险的随机对照试验和观察性研究进行了系统评价和荟萃分析。
我们检索了 PUBMED、EMBASE 和 Cochrane 对照试验中心注册数据库，以获取截至 2015 年 7 月发表的相关研究。我们使用固定效应模型和随机效应模型计算了 PPI 使用者与非 PPI 使用者 FGPs 和胃癌的汇总比值比（OR）和风险比（RR）。
我们分析了来自 12 项研究的数据，共纳入 87324 多名患者：1 项随机对照试验报告了 PPIs 对胃息肉（未指定部位）的影响，6 项队列研究和 1 项病例对照研究报告了 FGPs，1 项队列研究和 3 项病例对照研究报告了胃癌。固定效应模型和随机效应模型的汇总 OR 分别为 1.43（95%置信区间，1.24-1.64）和 2.45（95%置信区间，1.24-4.83）。每个模型的汇总 RR 为 1.43（95%置信区间，1.23-1.66）。我们观察到报告 FGPs 的研究之间存在显著异质性，但报告胃癌的研究之间无此差异。
基于系统评价和荟萃分析，长期使用 PPIs（≥12 个月）与 FGPs 风险增加相关。PPI 治疗可能也会增加胃癌风险，但由于研究数量有限且可能存在混杂因素，这种关联可能存在偏差。
