胃灼热和胃酸倒流药物使胃癌的风险增加一倍

胃灼热和胃酸倒流药物使胃癌的风险增加一倍

Proton pump inhibitors (PPIs) have an important role in the treatment of Helicobacter pylori. Proton-pump inhibitors (PPIs) are one of the most widely prescribed medications for heartburn and acid reflux worldwide. With profound gastric-acid suppression, concerns about a carcinogenic role in gastric cancer are noted, due to induced hypergastrinemia, gastric atrophy and bacterial overgrowth in the stomach. Daily Proton pump inhibitors usage is associated with a 4.55 times higher risk of cancer than baseline and became as high as an 8-fold greater risk if the drugs were taken for more than three years.

质子泵抑制剂(PPIs)在治疗幽门螺杆菌中具有重要作用。质子泵抑制剂(PPIs)是世界上最广泛使用的治疗胃灼热和胃酸倒流的处方药之一。随着胃酸的深度抑制，由于诱导的高胃泌素血症、胃萎缩和胃内细菌的过度生长，人们开始关注胃癌的致癌作用。每日使用质子泵抑制剂与癌症风险比基线高4.55倍相关，如果药物服用超过3年，其风险将增加8倍。

These drugs have been in the market for 25 years. Current evidence based on several observational studies suggests PPIs are linked to a greater-than-doubled risk of developing stomach cancer. A study conducted in 2017 revealed that long-term use of the medicine can increase stomach cancer risks by almost 250 percent. People who have an ongoing Helicobacter pylori infection and take a PPI stood a greater chance of developing a precursor to stomach cancer, called atrophic gastritis.

这些药物已经上市25年了。目前基于几项观察研究的证据表明，PPIs与胃癌发病风险增加一倍以上有关。2017年进行的一项研究显示，长期使用这种药物可使胃癌风险增加近250%。患有幽门螺杆菌持续感染并服用PPI的人更有可能发展为胃癌的前体，称为萎缩性胃炎。

In a new study published in the journal Gut, researchers from the University of Hong Kong and University College London, compared the use of PPIs with another drug type used to reduce production of acid termed histamine H2 receptor antagonists (H2 blockers) in 63,397 adults treated with triple therapy (combination of a PPI and two antibiotics to kill off H. pylori over 7 days) for stomach infection with H. pylori bacteria, between 2003 and 2012. Subsequently, these were monitored until they either developed stomach cancer, died, or the study ended (end of December 2015), whichever came first. The average monitoring period lasted 7.5 years.

在《内脏》杂志上发表的一项新研究中，香港大学和伦敦大学学院的研究人员比较了63的PPI与另一种用于减少被称为组胺H2受体拮抗剂(H2阻断剂)的酸的药物类型的用途。在2003年至2012年间，397名成人接受了三重治疗(在7天内联合使用一种PPI和两种抗生素杀死幽门螺杆菌)，以治疗幽门螺杆菌的胃感染。随后，对这些人进行监测，直到他们要么患上胃癌，要么死亡，要么研究结束(2015年12月底)，两者哪个先发生。平均监测期为7.5年。

During this mentioned period, 3271 (5%) people took Proton pump inhibitors for an average of nearly 3 years; and 21,729 took H2 blockers. It was seen that Total, 153 (0.24%) people had developed stomach cancer after triple therapy. None of those tested positive for H pylori at that time, but all of them had long standing gastritis (inflammation of the stomach lining). Those who had taken PPIs were linked with doubling and more (2.44) in the risk of developing stomach cancer, while taking H2 blockers was not associated with any such heightened risk. The average time frame in between triple therapy and the developing stomach cancer was under 5 years. The risk was proportional to the duration as well as frequency of usage of PPIs. Frequency of usage (higher usage) was associated with greater risk, daily use was linked to a more than quadrupling in risk (4.55) compared with that of weekly use.

在此期间，3271人(5%)平均服用质子泵抑制剂近3年;21729人服用了H2受体阻滞剂。共有153人(0.24%)在接受三联疗法后患上胃癌。当时没有人的幽门螺杆菌检测呈阳性，但他们都有长期的胃炎(胃粘膜的炎症)。那些服用过PPIs的人患胃癌的风险增加了一倍甚至更多(2.44)，而服用H2受体阻滞剂的人患胃癌的风险则没有增加。在三联疗法和胃癌之间的平均时间是5年以下。风险与PPIs的持续时间和使用频率成正比。使用频率(较高的使用频率)与更大的风险相关，每日使用与每周使用相比，风险增加了四倍多(4.55)。

The longer period PPIs were used, the greater was the risk of development of stomach cancer, rising the rate 5-fold after more than a year, to that of more than 6-fold after 2 or more years, and that of more than 8-fold after 3 or more years. Long-term using of PPIs was associated with around 4 additional cases of stomach cancer per 10,000 people per year.

PPIs使用的时间越长，胃癌的发展风险越大，一年多以后，胃癌发病率上升5倍，两年以上以后，上升到6倍以上，三年以上以后，上升到8倍以上。PPIs的长期使用与每年每1万人中增加4例胃癌有关。

Research done previously has linked long-term use of PPI to a number of other health problems including increased risk of heart attack, dementia, kidney problems, bone fractures, and tendon and ligament tears, and this study adds stomach cancer to the list of increased risks and dangerous side effects accompanying prolonged PPI-use. Even after the bacteria was killed, those who had taken PPIs on a long-term basis were more likely to develop stomach cancer in the following 7 to 8 years of follow-up. However, it could not tell if PPIs were the cause of the increased stomach cancer risk. It could also have been down to other factors.

先前的研究已经将长期使用PPI与许多其他健康问题联系起来，包括心脏病发作、痴呆、肾脏问题、骨折、肌腱和韧带撕裂的风险增加，本研究将胃癌列入长期使用PPI增加的风险和危险副作用的清单。即使在细菌被杀死后，那些长期服用PPIs的人在接下来的7到8年的随访中更容易患上胃癌。然而，它不能确定PPIs是否是胃癌风险增加的原因。这也可能是其他因素造成的。

The causation of developing stomach cancer is multifactorial. The reasonable explanation for the totality of evidence presented on this is that those who were given PPIs, and especially those who continued them for a longer period, tend to be sicker in a variety of ways than those for whom they are not prescribed. Hence, they are more likely to develop cancer anyway.

胃癌的发病是多因素的。对这方面所提出的全部证据的合理解释是，那些被给予PPIs的人，特别是那些长期服用PPIs的人，往往在各种方面比那些没有被给予PPIs的人更容易患病。因此，无论如何，他们更容易患上癌症。

Hence, it is recommended to reduce the consumption of PPIs to the minimum required period. Dietary and lifestyle changes are preferred to reduce the acid reflux, which will have a prolonged result with reduced risk for development of stomach cancer.

因此，建议将PPIs的消耗量减少到所需的最短时间。饮食和生活方式的改变有利于减少胃酸倒流，这将有一个长期的结果，降低胃癌的发展风险。