Helicobacter pylori eradication failure may have confounded the recent large-scale health database study that showed proton pump inhibitors increase gastric cancer risk

The current guidelines recommend that when patients require long-term use of proton pump inhibitors (PPIs), Helicobacter pylori (H. pylori) should be eradicated beforehand because it improves atrophic gastritis, a precancerous lesion.1 2 The recent analysis by Cheung et al3 of the data of more than 60 000 adults registered in a territory-wide health database in Hong Kong who underwent H. pylori eradication showed that the long-term use of PPIs increased the risk of gastric cancer by 2.4-fold. Moreover, the risk of gastric cancer increased with the dose and duration of PPI use. The fact that long-term PPI administration increases the risk of gastric cancer even after H. pylori eradication is unexpected.

However, the study has some limitations. First, although it is based on a large sample, it is an observational study rather than a prospective randomised interventional study. As a result, the clinical backgrounds of the PPI user...

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