Is administration of proton pump inhibitors in functional dyspepsia worth the risk of developing gastric cancer: a Markov model to bridge the gap between scientific evidence and clinical practice

Published on Feb 12, 2020in BMJ Open2.692
· DOI :10.1136/BMJOPEN-2019-031091
Efrat Broide24
Estimated H-index: 24
,
Adi Eindor-Abarbanel3
Estimated H-index: 3
+ 3 AuthorsMoshe Leshno31
Estimated H-index: 31
(TAU: Tel Aviv University)
Sources
Abstract
Objective To formulate a decision analysis model based on recently published data that addresses the dilemma, whether improvement in quality of life rationalises continued proton pump inhibitors (PPI) use despite the risk of gastric cancer (GC) in patients with functional dyspepsia (FD). Design A Markov model consisting of an initial decision regarding treatment with PPI (denoting it by PPI strategy) or any other treatment without PPI (denoting it by placebo strategy) was designed. Data sources Data from prospective cross-sectional studies indicating risk stratification for GC after the use of PPI, combined with a Markov model that comprised the following states: Live, GC stages 1–4, Death. Outcome measures The primary outputs included quality-adjusted life years (QALYs) and life expectancy (LE). The improvement in utility in FD without PPI as compared with PPI use was tested (PPI vs placebo strategies). Sensitivity analyses were performed to evaluate the robustness of the model and address uncertainty in the estimation of model parameters. Setting We considered only patients whose symptoms were relieved with PPIs and thus, had a better quality of life compared with patients who did not receive PPIs. Results The base case model showed that PPIs compared with placebo decreased LE by 58.4 days with a gain of 2.1 QALY. If utility (quality of life of patients with FD using PPI compared with patients with FD without PPI) improved by more than 0.8%, PPI use is considered better than placebo. Older patients benefited less from PPI treatment than did younger patients. Conclusion To bridge the gap between evidence and decision making, we found that even a small improvement in the QALY justified continuing PPI treatment.
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References33
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#2Keith Gillis (Glas.: University of Glasgow)H-Index: 6
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Background: Proton pump inhibitors (PPIs) are associated with acute tubulointerstitial nephritis and there are reports associating their use with the development of chronic kidney disease (CKD). Aim: To determine if PPI use is associated with major adverse renal events (MARE) in patients with CKD. Design: Observational cohort study comprising patients with CKD attending secondary care renal clinics from 1 January 2006 until 31 December 2016. Methods: We collated baseline clinical, socio-demograp...
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#1Surapon Nochaiwong (CMU: Chiang Mai University)H-Index: 7
#2Chidchanok Ruengorn (CMU: Chiang Mai University)H-Index: 10
Last. Kednapa Thavorn (Ottawa Hospital Research Institute)H-Index: 26
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Background: Existing epidemiological studies illustrate that proton pump inhibitors (PPIs) may be related to adverse kidney outcomes. To date, no comprehensive meta-analysis has been conducted to evaluate and quantify this association. Methods: We performed a systematic review and meta-analysis of studies to assess the association between PPI use and the risk of adverse kidney outcomes. We searched MEDLINE, Embase, SCOPUS, Web of Science, CINAHL, Cochrane Library and grey literature with no lang...
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OBJECTIVE: The present study was designed to investigate whether AJCC/UICC 8th edition staging system precisely differentiated patients with different prognosis of gastric cancer (GC). METHODS: There were 540 GC cases included in this study. Stratification was done according to the 7th and 8th AJCC/UICC tumor-node-metastasis (TNM) staging systems. Detailed comparison was conducted between two editions in terms of the sub-classification of pN3 stage, redefinitions of stage III, homogeneity, discr...
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#2Esther W. Chan (HKU: University of Hong Kong)H-Index: 29
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Objective Proton pump inhibitors (PPIs) is associated with worsening of gastric atrophy, particularly in Helicobacter pylori (HP)-infected subjects. We determined the association between PPIs use and gastric cancer (GC) among HP-infected subjects who had received HP therapy. Designs This study was based on a territory-wide health database of Hong Kong. We identified adults who had received an outpatient prescription of clarithromycin-based triple therapy between year 2003 and 2012. Patients who ...
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Last. Katsuhiko IwakiriH-Index: 25
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Patients with functional dyspepsia, defined in the 2016 Rome IV criteria as bothersome clinical dyspepsia symptoms, experience markedly reduced quality of life. Several etiologies have been associated with the disorder. In the Rome IV criteria, the brain–gut axis was acknowledged as an important factor in the etiology of functional gastrointestinal (GI) disorders. The distinct subgroups of functional dyspepsia, epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS), are treated ...
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#2Yuhong Yuan (McMaster University)H-Index: 38
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Background Functional dyspepsia (FD or non-ulcer dyspepsia) is defined as continuous or frequently recurring epigastric pain or discomfort for which no organic cause can be found. Acid suppressive therapy, including proton pump inhibitors (PPIs), has been proposed as a therapeutic option in FD, but its efficacy remains controversial. While PPIs are generally considered safe and well tolerated, they have been associated with adverse events, especially in the long term. For this reason, decisions ...
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Objective Proton pump inhibitors (PPIs) are among the most commonly prescribed drugs. Concerns have been raised about a potentially increased risk of gastric cancer following long-term use. Our aim is to assess the risk of gastric cancer associated with PPI use, taking into account underlying indications. Design This is a population-based cohort study. Standardised incidence ratios (SIRs) and 95% CIs were calculated to compare the risk of gastric cancer among long-term PPI users with the corresp...
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Abstract Oesophago-gastric cancers (oesophageal and gastric cancers) are common, highly fatal cancers. Oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC) are the two main histological subtypes of oesophageal cancer. Globally, OSCC remains the most common histological subtype of oesophageal cancer, with the highest burden occurring along two geographic belts, one from north central China through the central Asian republics to northern Iran, and one from eastern to sou...
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We have updated both the American College of Gastroenterology (ACG) and the Canadian Association of Gastroenterology (CAG) guidelines on dyspepsia in a joint ACG/CAG dyspepsia guideline. We suggest that patients ≥60 years of age presenting with dyspepsia are investigated with upper gastrointestinal
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#1Taline Boghossian (Ottawa Hospital)H-Index: 2
#2Farah Joy Rashid (Ottawa Hospital)H-Index: 2
Last. Barbara Farrell (U of O: University of Ottawa)H-Index: 24
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Background Proton pump inhibitors (PPIs) are a class of medications that reduce acid secretion and are used for treating many conditions such as gastroesophageal reflux disease (GERD), dyspepsia, reflux esophagitis, peptic ulcer disease, and hypersecretory conditions (e.g. Zollinger-Ellison syndrome), and as part of the eradication therapy for Helicobacter pylori bacteria. However, approximately 25% to 70% of people are prescribed a PPI inappropriately. Chronic PPI use without reassessment contr...
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#1Seung In Seo (Hallym University)H-Index: 8
#2Chan Hyuk Park (Hanyang University)H-Index: 17
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Objective The association between proton pump inhibitor (PPI) use and gastric cancer related to Helicobacter pylori eradication has not been fully investigated in geographical regions with high risk of gastric cancer. We aimed to evaluate the association between PPIs and gastric cancer in Korea. Design This study analysed the original and common data model versions of the Korean National Health Insurance Service database from 2002 to 2013. We compared the incidence rates of gastric cancer after ...
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