British Medical Journals (BMJ):

Introduction

Proton pump inhibitors (PPIs) are commonly prescribed drugs indicated for several gastric conditions, including peptic ulcer disease, GERD and Barrett’s oesophagus.

Recent evidence suggests that PPIs are commonly overprescribed, either in patients without an evidence-based indication for use or longer durations than necessary. This is particularly relevant as several observational studies have associated the use of PPIs with different adverse health outcomes, including GI malignancies such as colorectal cancer.

Hypergastrinaemia may be induced by prolonged use of PPIs, which in turn, may be associated with the development of colorectal cancer, as hypergastrinaemia has been shown to promote the proliferation of both normal and malignant colonic and rectal cancer cells in vitro.

While animal models suggest that hypergastrinaemia leads to adenoma progression, an important precursor to colorectal cancer, the association between PPI use and adenomatous polyps has not been shown consistently in humans.

To date, several observational studies that investigated the association between PPI use and colorectal cancer have generated conflicting findings and had important methodological shortcomings.

Given the conflicting observational evidence, it remains unclear whether the use of PPIs is associated with the incidence of colorectal cancer, a leading cause of cancer death with an increasing incidence among younger adults.  

Thus, the objective of this large population-based cohort study is to determine whether the use of PPIs, when compared with the use of H2RAs, is associated with an increased risk of colorectal cancer.

Key Messages:

What is already known about this subject?

Previous observational studies present conflicting evidence regarding the association between proton pump inhibitor use and colorectal cancer incidence.

Previous studies have been limited by small sample sizes, short durations of follow-up, and other methodological shortcomings.

What are the new findings?

The results of this study suggest that any use of proton pump inhibitors is not associated with an increased risk of colorectal cancer.

However, prolonged durations of use of proton pump inhibitors may be associated with a modest increased risk of colorectal cancer.

How might it impact on clinical practice in the foreseeable future?

Given that proton pump inhibitors are commonly overprescribed for inappropriately long durations, this study highlights the need to reassess the need for ongoing treatment regularly.

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