Shiratori Yasutoshi, Ikeya Takashi, Ishii Naoki, Yamamoto Kazuki, Honda Tetsuro, Hasatani Kenkei, Yoshida Naohiro, Nishida Tsutomu, Sumiyoshi Tetsuya, Kiyotoki Shu, Arai Masahiro, Niikura Ryota
Department of Gastroenterology St. Luke's International Hospital Tokyo Japan.
Department of Gastroenterology Tokyo Shinagawa Hospital Tokyo Japan.
JGH Open. 2021 Jan 29;5(3):371-376. doi: 10.1002/jgh3.12503. eCollection 2021 Mar.
Although gastric acid suppressants such as proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are considered safe, the consequences of hypochlorhydria and hypergastrinemia caused by chronic use are unclear. This study aimed to investigate the association between the chronic use of gastric acid suppressants and high-risk colorectal polyps, focusing on polyp size.
A population-based, nested case-control study was conducted using data from the Japanese Diagnosis Procedure Combination database between 2014 and 2019. Cumulative PPI or H2RA use prior to polypectomy was evaluated during the study period. Endoscopic polypectomy was categorized as polypectomy <2 cm, polypectomy ≥2 cm, and endoscopic submucosal dissection. Baseline characteristics were compared between the high-risk (≥2 cm polyps or polyps treated by endoscopic submucosal dissection) and low-risk (<2 cm polyps) endoscopic polypectomy groups. We calculated adjusted odds ratios (ORs) using multivariable logistic regression analysis.
Of 27 694 patients who underwent endoscopic polypectomy, 2518 were treated with PPIs or H2RAs for >1 year prior to polypectomy. After adjusting for age, gender, and other confounders, a higher prevalence of high-risk colorectal polyps was noted with PPI (OR: 2.67; 95% confidence interval: 2.37-3.01) and H2RA (OR: 1.86; 95% confidence interval: 1.52-2.26) use. Longer PPI or H2RA use was associated with increased risks of high-risk colorectal polyps ( for trend <0.001). The highest OR (3.17) was observed among patients who received PPIs for ≥3 years.
Chronic use of PPIs and H2RAs may be associated with high-risk colorectal polyps. Requirements for long-term gastric acid suppressant use should be reevaluated.
尽管诸如质子泵抑制剂（PPIs）和组胺-2受体拮抗剂（H2RAs）等胃酸抑制剂被认为是安全的，但长期使用导致胃酸过少和高胃泌素血症的后果尚不清楚。本研究旨在探讨长期使用胃酸抑制剂与高危结直肠息肉之间的关联，重点关注息肉大小。
利用2014年至2019年日本诊断程序组合数据库的数据进行了一项基于人群的巢式病例对照研究。在研究期间评估了息肉切除术前PPI或H2RA的累积使用情况。内镜下息肉切除术分为息肉切除<2 cm、息肉切除≥2 cm和内镜黏膜下剥离术。比较高危（息肉≥2 cm或经内镜黏膜下剥离术治疗的息肉）和低危（息肉<2 cm）内镜下息肉切除术组的基线特征。我们使用多变量逻辑回归分析计算调整后的比值比（OR）。
在27694例行内镜下息肉切除术的患者中，2518例在息肉切除术前接受PPI或H2RA治疗超过1年。在调整年龄、性别和其他混杂因素后，使用PPI（OR：2.67；95%置信区间：2.37 - 3.01）和H2RA（OR：1.86；95%置信区间：1.52 - 2.26）的患者中高危结直肠息肉的患病率更高。PPI或H2RA使用时间越长，高危结直肠息肉的风险越高（趋势P<0.001）。在接受PPI治疗≥3年的患者中观察到最高的OR（3.17）。
长期使用PPI和H2RA可能与高危结直肠息肉有关。应重新评估长期使用胃酸抑制剂的必要性。
