No increased risk of stomach cancer with long-term medication for heartburncan
Long-term use of medications for heartburn and acid reflux, known as proton pump inhibitors, does not appear to increase the risk of stomach cancer, according to a new study published in The BMJ. The results are based on extensive Nordic health data and may provide reassurance to patients who need long-term treatment, according to researchers at Karolinska Institutet.
The possibility that proton pump inhibitors could cause stomach cancer has been discussed since the 1980s. Overall, studies have shown a doubled risk, but the studies have had methodological shortcomings. To investigate the association, taking into account a number of possible sources of error in previous literature in the field, researchers analysed registry data from the five Nordic countries—Denmark, Finland, Iceland, Norway, and Sweden—over a period of up to 26 years.
The study included 17,232 people with stomach cancer and compared them with over 172,000 control subjects matched for age, sex, year, and country. The researchers investigated the use of proton pump inhibitors and another type of acid-suppressing drug, histamine-2 receptor blockers. To avoid methodological errors, drug use in the last year before diagnosis was excluded, as were patients who had cancer in the upper part of the stomach, where heartburn is a risk factor. The results were also adjusted for factors such as Helicobacter pylori infection, stomach ulcers, smoking, alcohol-related diseases, obesity, diabetes, and certain medications.
By using this methodological approach, the researchers found no association between long-term use of these drugs and the risk of stomach cancer.
“Our results contradict the hypothesis that proton pump inhibitors cause stomach cancer,” says the lead researcher responsible for the study, Professor Jesper Lagergren at the Department of Molecular Medicine and Surgery, Karolinska Institutet. He continues:
“This provides reassurance for patients who need long-term treatment and is important for clinical decisions.”
The researchers emphasise that the study is observational, which means that no definitive conclusions can be drawn about cause and effect. Nor can it be completely ruled out that confounding factors that could not be adjusted for have influenced the results. However, the study design allows for more reliable results than previous research.
The study was funded by the Swedish Cancer Society, the Nordic Cancer Union, the Swedish Research Council, the Radiumhemmet Research Funds, Region Stockholm and Karolinska Institutet (ALF). The researchers report no conflicts of interest.
Publikation
”Long-term use of proton pump inhibitors and risk of stomach cancer: population-based case-control study in the five Nordic countries”, Onyinyechi Duru, Giola Santoni, Dag Holmberg, Helgi Birgisson, Joonas H. Kauppila, My von Euler-Chelpin, Eivind Ness-Jensen, Jesper Lagergren, The BMJ, online 21 januari 2025, doi: 10.1136/bmj-2025-086384