Maintenance proton pump inhibitor use and risk of colorectal cancer: a Swedish retrospective cohort studyShow others and affiliations
2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 7, article id e079591
Article in journal (Refereed) Published
Abstract [en]
OBJECTIVES: We aimed to evaluate the risk of colorectal adenocarcinoma (CRA) associated with long-term use of proton pump inhibitors (PPIs) in a large nationwide cohort.
DESIGN: Retrospective cohort study.
SETTING: This research was conducted at the national level, encompassing the entire population of Sweden.
PARTICIPANTS: This study utilised Swedish national registries to identify all adults who had ≥180 days of cumulative PPI use between July 2005 and December 2012, excluding participants who were followed up for less than 1 year. A total of 754 118 maintenance PPI users were included, with a maximum follow-up of 7.5 years.
INTERVENTIONS: Maintenance PPI use (cumulative≥180 days), with a comparator of maintenance histamine-2 receptor antagonist (H2RA) use.
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the risk of CRA, presented as standardised incidence ratios (SIRs) with 95% confidence intervals (CIs). Subgroup analyses were performed to explore the impact of indications, tumour locations, tumour stages and the duration of follow-up. A multivariable Poisson regression model was fitted to estimate the incidence rate ratios (IRRs) and 95% CIs of PPI versus H2RA use.
RESULTS: Maintenance PPI users exhibited a slightly elevated risk of CRA compared to the general population (SIR 1.10, 95% CI=1.06 to 1.13) for both men and women. Individuals aged 18-39 (SIR 2.79, 95% CI=1.62 to 4.47) and 40-49 (SIR 2.02, 95% CI=1.65 to 2.45) had significantly higher risks than the general population. Right-sided CRA showed a higher risk compared to the general population (SIR 1.26, 95% CI=1.20 to 1.32). There was no significant difference in the risk of CRA between maintenance PPI users and maintenance H2RA users (IRR 1.05, 95% CI=0.87 to 1.27, p<0.05).
CONCLUSIONS: Maintenance PPI use may be associated with an increased risk of CRA, but a prolonged observation time is needed.
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024. Vol. 14, no 7, article id e079591
Keywords [en]
CLINICAL PHARMACOLOGY, EPIDEMIOLOGIC STUDIES, GASTROENTEROLOGY, Gastrointestinal tumours, REGISTRIES, Risk Factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-114609DOI: 10.1136/bmjopen-2023-079591ISI: 001265212100035PubMedID: 38960460Scopus ID: 2-s2.0-85197662994OAI: oai:DiVA.org:oru-114609DiVA, id: diva2:1881873
Funder
Swedish Society of Medicine, SLS-788731; SLS-78875; SLS-783091Swedish Research Council, 2020-010582024-07-042024-07-042024-08-21Bibliographically approved