Heartburn Meds Risk Of Pancreatic Cancer. New information is once again putting the safety of proton pump inhibitors (PPIs) under scrutiny. Researchers in one study at the University of Pennsylvania found that PPIs were connected to an increased risk for pancreatic cancer. Another study reported in the BMJ Open (formerly the British Medical Journal), that military veterans who took PPIs had a small but marked increased risk for premature death as opposed to those who took other reflux drugs or no similar medication, according to Gastroenterology and Endoscopy News.
Dr. Malcolm Kearns, a resident of internal medicine at the Hospital at the University of Pennsylvania in Philadelphia said, “There’s a lot of laboratory data to suggest links between the trophic hormone gastrin and abnormal cell growth of various types, and one key medication known to cause gastrin elevation is [the] PPI.”
Dramatic Increase in PPI Use
Dr. Kearns worked on the study examining pancreatic cancer and added, “The number of prescriptions for PPIs has skyrocketed in recent years – many are started and continued without appropriate indications or regular evaluation. So, we wanted to examine at a population level whether there was an association between pancreatic cancer and PPIs.”
The researchers sought to evaluate the relationship between pancreatic cancer and PPIs along with the survival after the disease is diagnosed. They used the Health Improvement Network, a medical records database representative of the United Kingdom population. The study matched patients with pancreatic cancer with as many as four controls based on age, sex, practice site, duration, and calendar time of follow-up, reports Gastroenterology and Endoscopy News.
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Researchers compared in the retrospective cohort study, the survival of pancreatic cancer patients according to how long they had been taking PPIs at the time they were diagnosed. The researchers analyzed 4,113 pancreatic cancer patients and 16,072 matched controls. They discovered that cancer patients were more likely to be using PPIs at the time of the study (53 percent vs. 26 percent).
This group was also more likely to smoke, to use alcohol, to be obese, and to have diabetes. Compared with controls, the amount of time of PPI use, was found to be significantly lower in pancreatic patients. After adjusting for body mass index, investigators found, both active and former PPI users had an increased risk for pancreatic cancer.
“A modest decrease” was also found in survival after diagnosis of pancreatic cancer in short-term, active PPI users, identified as having received their initial PPI prescription less than 12 months before beginning the study.
The study was called “well done and thoughtful” by Dr. Philip Katz, director of Motility Laboratories for the Division of Gastroenterology at the Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medicine, in New York City. Dr. Katz, however, disagreed with the conclusion that PPIs increased the risk for pancreatic cancer.
“One would suspect a confounder such as GERD [gastroesophageal reflux disease], or that the patients’ symptoms were suggestive of an acid-related problem, but were likely from the cancer instead. What this really reinforces, as do many studies like it, is that we shouldn’t be prescribing these drugs without a solid indication,” said Dr. Katz.
Recognizing this point, Dr. Kearns said, “What could have caused that increased odds ratio within six months [in short-term PPI users], could have been the symptoms of pancreatic cancer itself. But what we found compelling about our data was that the elevated OR [odds ratio] was persistent even up to 24 months prior to diagnosis of pancreatic cancer.”
Dr. Kearns added, “The reason that’s significant is that the mean survival following diagnosis of pancreatic cancer is around six months. So, it would be unlikely that patients that were prescribed PPIs two years prior to diagnosis of pancreatic cancer were started on them because of symptoms of pancreatic cancer.”
Mortality Risk Factors
Researchers at Washington University School of Medicine in St. Louis and the VA St. Louis Health Care System in the BMJ study examined death rates among a large cohort of male veterans. Approximately 350,000 had begun taking a PPI or histamine H2 receptor antagonist between October 2006 and September 2008 and were on the medications for an average of about 5.7 years.
Participants who took PPIs had a 15 percent increased risk (23 percent) for death during the study period compared with those who did not use PPIs, researchers said. The difference in mortality was greater for individuals who took a PPI without a documented GI (gastrointestinal) disorder, and it seemed to increase with duration of use.
“Limiting PPI use and duration to instances where it is medically indicated may be warranted,” the researchers wrote.