Kang Seung Joo, Lee Kwang Jae
Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea.
J Neurogastroenterol Motil. 2025 Apr 30;31(2):178-185. doi: 10.5056/jnm24145.
BACKGROUND/AIMS: Although the association between the use of proton pump inhibitors (PPIs) and the risk of gastric cancer has been postulated in casecontrol and cohort studies, it remains still controversial. We aim to evaluate association of PPI use with gastric cancer in regions with high prevalence of gastric cancer, particularly in patients who underwent eradication of , by systemic review and meta-analysis.
Comprehensive literature search through the PubMed, Embase, and Cochrane database was performed in October 2023. We used random effects model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs) between PPI use and gastric cancer. The Cochran Q-statistic and the test were employed for evaluating potential heterogeneity between studies.
Two case-control and 6 cohort studies were identified. PPI use was significantly associated with the development of gastric cancer (OR, 2.02; 95% CI, 1.35-3.01). In subgroup analysis carried out according to the study design, sample size, and adjustment of confounding factors (age, sex, and ), such association was significant. A meta-analysis of 4 studies performed in patients with eradication history showed that the use of PPIs was significantly associated with an elevated incidence of gastric cancer (OR, 2.10; 95% CI, 1.48-2.97).
Long-term use of PPIs is associated with an increased risk of gastric cancer in Asian regions with high prevalence of gastric cancer, particularly in subjects who have eradication history of . Optimization of long-term PPI use seems to be necessary in regions where gastric cancer is prevalent.
背景/目的：尽管在病例对照研究和队列研究中已假定使用质子泵抑制剂（PPI）与胃癌风险之间存在关联，但仍存在争议。我们旨在通过系统评价和荟萃分析，评估在胃癌高发地区使用PPI与胃癌的关联，特别是在接受过根除治疗的患者中。
2023年10月通过PubMed、Embase和Cochrane数据库进行了全面的文献检索。我们使用随机效应模型计算PPI使用与胃癌之间的合并比值比（OR）及其95%置信区间（CI）。采用Cochran Q统计量和I²检验评估研究间的潜在异质性。
共纳入两项病例对照研究和六项队列研究。使用PPI与胃癌发生显著相关（OR = 2.02；95% CI：1.35 - 3.01）。根据研究设计、样本量和混杂因素（年龄、性别和幽门螺杆菌感染状况）调整进行的亚组分析显示，这种关联具有统计学意义。对四项有幽门螺杆菌根除史患者的研究进行的荟萃分析表明，使用PPI与胃癌发病率升高显著相关（OR = 2.10；95% CI：1.48 - 2.97）。
在胃癌高发的亚洲地区，长期使用PPI与胃癌风险增加相关，尤其是在有幽门螺杆菌根除史的人群中。在胃癌流行地区，似乎有必要优化PPI的长期使用。
