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In a recent "BMJ family highlights" section (1), a brief description
was published in the BMJ of a study of the effect of omeprazole on
mortality, which had been published in Gut(2). In this study, patients had
been followed-up for four years after at least one month`s treatment with
omeprazole in the year before inclusion. No excess mortality was shown in
the treated group over the four years of follow-up, in particular no
excess mortality for gastric cancer. However, Marcovitch states in his
summary of this study in the BMJ: "Theoretical concerns that omeprazole
might predispose to gastric cancer... have been discounted"(2).
This conclusion is certainly not one suggested by the authors in the
original article, since their data could neither confirm nor refute such a
hypothesis. Any such risk would theoretically be limited to patients with
chronic, prolonged use, not in patients where a significant proportion may
have had short-term use, as in the described study. Furthermore,
experience with acid-reducing gastric surgery demonstrates that any such
risk would be measured in decades, not over the relatively short period of
four years (3).
In summary, Marcovitch`s inference from this study is potentially
highly misleading for a general readership. The theoretical risk of
gastric cancer with the long-term use of these ubiquitous drugs will
require continuing long-term vigilance and further mechanistic research in
the interim. Such goals will be potentially undermined by the misleading
reporting of studies in this area.
1 Marcovitch H. Omeprazole does not increase the risk of dying.BMJ
2003; 327: 125.
2 Bateman DN, Colin-Jones D, Hartz S et al. Mortality study of 18 000
patients treated with omeprazole. Gut 2003; 52: 942-946.
3 Lundegardh G, Adami HO, Helmick C et al. Stomach cancer after partial
gastrectomy for benign ulcer disease. NEJM 1988; 319: 195-200.
The following statement from the paper in Gut about omeprazole and
the risk of gastric neoplasia counters your statement that "theoretical
concerns that omeprazole might predispose to gastric cancer or hinder
disease recognition have been discounted".
"Our results are reassuring given concern that treatment might cause
early gastric atrophy,23,24 although any increased incidence of gastric
atrophy associated with antisecretory treatment might take longer than the
period under review to influence mortality from gastric cancer".Gut
2003;52: 942-6
As ever, it pays not to jump to any conclusion too early!
The long-term safety of PPIs is not yet proven
In a recent "BMJ family highlights" section (1), a brief description
was published in the BMJ of a study of the effect of omeprazole on
mortality, which had been published in Gut(2). In this study, patients had
been followed-up for four years after at least one month`s treatment with
omeprazole in the year before inclusion. No excess mortality was shown in
the treated group over the four years of follow-up, in particular no
excess mortality for gastric cancer. However, Marcovitch states in his
summary of this study in the BMJ: "Theoretical concerns that omeprazole
might predispose to gastric cancer... have been discounted"(2).
This conclusion is certainly not one suggested by the authors in the
original article, since their data could neither confirm nor refute such a
hypothesis. Any such risk would theoretically be limited to patients with
chronic, prolonged use, not in patients where a significant proportion may
have had short-term use, as in the described study. Furthermore,
experience with acid-reducing gastric surgery demonstrates that any such
risk would be measured in decades, not over the relatively short period of
four years (3).
In summary, Marcovitch`s inference from this study is potentially
highly misleading for a general readership. The theoretical risk of
gastric cancer with the long-term use of these ubiquitous drugs will
require continuing long-term vigilance and further mechanistic research in
the interim. Such goals will be potentially undermined by the misleading
reporting of studies in this area.
1 Marcovitch H. Omeprazole does not increase the risk of dying.BMJ
2003; 327: 125.
2 Bateman DN, Colin-Jones D, Hartz S et al. Mortality study of 18 000
patients treated with omeprazole. Gut 2003; 52: 942-946.
3 Lundegardh G, Adami HO, Helmick C et al. Stomach cancer after partial
gastrectomy for benign ulcer disease. NEJM 1988; 319: 195-200.
Competing interests:
None declared
Competing interests: No competing interests