Open AccessDose‐dependent association of proton pump inhibitors use with gastric intestinal metaplasia among Helicobacter pylori‐positive patients
Author(s) -
Snir Yifat,
Leibovitzh Haim,
LeiboviciWeissman Yaara,
Vilkin Alex,
Cohen Ar D.,
Shochat Tzippy,
Niv Yaron,
Dotan Iris,
Feldhamer Ilan,
Boltin Doron,
Levi Zohar
Publication year - 2021
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620951403
Subject(s) - helicobacter pylori , medicine , gastroenterology , proton pump inhibitor , intestinal metaplasia , odds ratio , confidence interval , atrophic gastritis , esomeprazole , gastritis
Background Gastric intestinal metaplasia is a pre‐cancerous condition associated with multiple factors. Objective We evaluated whether cumulative proton pump inhibitor dose is associated with the diagnosis of gastric intestinal metaplasia while controlling for multiple variables. Methods We retrospectively identified patients who underwent upper endoscopy with gastric biopsy between 2005 and 2014. Covariate data retrieved included age, sex, ethnicity, smoking status, Helicobacter pylori status (based on clarithromycin‐amoxicillin‐proton pump inhibitor issued), cumulative proton pump inhibitor issued within 10 years (quartiles [PPI‐Q 1–4 ] of daily drug dose), anti‐parietal cell antibodies, body mass index and comorbidity index. Results Of the 14,147 included patients (median age 63.4 years; women 54.4%; Helicobacter pylori‐positive 29.0%), 1244 (8.8%) had gastric intestinal metaplasia. Increasing age, Helicobacter pylori infection, smoking, anti‐parietal cell antibodies and proton pump inhibitor use were all associated with the diagnosis of gastric intestinal metaplasia. Upper quartiles of cumulative proton pump inhibitor doses (PPI‐Q 4 and PPI‐Q 3 vs. PPI‐Q 1 ) were associated with the diagnosis of gastric intestinal metaplasia: adjusted odds ratios 1.32 (95% confidence interval [CI] 1.111.57) and 1.27 (95% CI 1.07–1.52), respectively, for the whole cohort (P total 0.007, P trend 0.013), 1.69 (95% CI 1.23–2.33) and 1.40 (95% CI 1.04–1.89), respectively, for Helicobacter pylori‐positive patients (P total 0.004, P trend 0.005) and 1.21 (95% CI 0.98–1.49) and 1.20 (95% CI 0.96–1.49), respectively, for Helicobacter pylori‐negative patients (P total 0.288, P trend 0.018). Upper quartiles of proton pump inhibitor dose were associated with a 5–10‐fold increased risk of low‐grade dysplasia. Conclusions Among Helicobacter pylori‐positive patients, proton pump inhibitor use appears to be associated with a dose‐dependent increased likelihood of gastric intestinal metaplasia.