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Use of Acid-Suppressant Medications After Diagnosis Increases Mortality in a Subset of Gastrointestinal Cancer Patients.
Ayyagari S, Tan MC, Liu Y, El-Serag HB, Thrift AP. Use of Acid-Suppressant Medications After Diagnosis Increases Mortality in a Subset of Gastrointestinal Cancer Patients. Digestive diseases and sciences. 2020 Sep 1; 65(9):2691-2699.
Acid-suppressant medications, including proton pump inhibitors (PPIs) and H receptor antagonists (HRAs), are frequently prescribed and have been linked to increased risk of some gastrointestinal cancers.
We examined whether post-diagnosis use of PPIs/HRAs is associated with the risk of mortality in gastrointestinal cancer patients.
We used data from patients with esophageal cancer, gastric cancer, or hepatocellular carcinomas (HCCs) in the national VA Central Cancer Registry diagnosed between 2002 and 2016. We identified PPI/HRA prescriptions that were filled before and after cancer diagnosis and used time-dependent Cox regression models to calculate adjusted hazard ratios (HRs) and 95% CIs for mortality risk. We used a time-varying exposure to avoid immortal-time bias and a 3-month lag to reduce reverse causation. A sensitivity analysis was conducted varying the lag duration between the date of cancer diagnosis and the start of follow-up.
PPIs were used by the majority (54% post-diagnosis use) of patients. We found no association between post-diagnosis PPI use and cancer-specific mortality in esophageal adenocarcinoma (HR 0.93; 95% CI 0.84-1.02), esophageal squamous cell carcinoma (HR 0.99; 95% CI 0.87-1.12), or gastric cardia cancer (HR 1.04; 95% CI 0.89-1.22) patients. Post-diagnosis PPI use was, however, associated with the increased risk of cancer-specific mortality for patients with gastric non-cardia cancer (HR 1.50; 95% CI 1.29-1.74) and HCC (HR 1.31; 95% CI 1.23-1.40). The results were similar for associations with post-diagnosis use of HRAs. There was no association with pre-diagnosis PPI/HRA use.
Post-diagnosis PPI/HRA use was associated with the increased mortality in gastric non-cardia cancer and HCC patients.