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General medicine
Proton pump inhibitor therapy after Helicobacter pylori eradication may increase the risk of gastric cancer
  1. Mimi Chang Tan,
  2. David Y Graham
  1. Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr David Y Graham, Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA; dgraham{at}

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Commentary  on: Cheung KS, Chan EW, Wong AYS, et al. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Gut 2018; 67:28–35


Helicobacter pylori infection is the most common cause of gastric cancer. Whether H. pylori eradication reduces or eliminates the risk of gastric cancer depends on the risk at the time of cure. In those with mucosal damage and hypochlorhydria, H. pylori eradication may result in return of acid secretion. Proton pump inhibitor (PPI) therapy can profoundly reduce acid secretion after H. pylori therapy. However, the effect of PPIs on the risk of gastric cancer after H. pylori eradication is unknown.


Cheung et al reported a population-based study to determine whether PPI use after H. pylori eradication altered the risk of subsequent gastric cancer.1 The study cohort consisted of Hong Kong residents whose H. pylori infection was cured using clarithromycin-containing triple therapy from 2003 to 2012. They excluded those with previous gastrectomy, gastric cancer within 1 year of H. pylori therapy, failed H. pylori eradication or incident gastric ulcer after therapy. Development of …

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  • Contributors All authors have read and approved the final manuscript and each meets the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the results reported.

  • Funding This study was funded by National Institute of Diabetes and Digestive and Kidney Diseases (grant no. DK56338).

  • Competing interests DYG is supported by Public Health Service grant DK56338, which funds the Texas Medical Center Digestive Diseases Center. DYG is a consultant for RedHill Biopharma regarding novel Helicobacter pylori therapies and has received research support for culture of H. pylori and is the PI of an international study of the use of antimycobacterial therapy for Crohn’s disease. He is also a consultant for BioGaia in relation to probiotic therapy for H. pylori infection and for Takeda in relation to H. pylori therapies.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.