Association Between Proton Pump Inhibitor Use and Gastric Neuroendocrine Neoplasms in Autoimmune Gastritis: A Real-World Propensity Score-Matched Study From the Autoimmune gastRitis Italian netwOrk Study grOup.

Massironi S, Lenti MV, Lahner E, +8 more, Autoimmune gastRitis Italian netwOrk Study grOup (ARIOSO).

Journal ArticleAbstract only — full text under license

AI summary — for doctors, generated from the abstract only

Proton pump inhibitor use was associated with more gastric neuroendocrine neoplasms in patients with autoimmune gastritis.

What was studied

Retrospective propensity-score-matched TriNetX cohort of 40,489 matched patients per arm with autoimmune gastritis, comparing PPI exposure with none.

Key findings

gNENs occurred in 0.89% with PPIs vs 0.60% without (RR 1.49).
Time-to-event analysis agreed (HR 1.44), and incident-tumor analysis was also positive.
PPI use was consistently associated with hypergastrinemia and gastric mucosal changes including intestinal metaplasia.

Clinical relevance

It raises caution about long-term PPI use in autoimmune gastritis, where hypergastrinemia already raises gNEN risk.

Who should care

Medical Gastroenterology

Limitations

Retrospective coded database study with possible confounding by indication, surveillance bias and no information on PPI dose or duration.

Reassess whether PPIs are truly needed in autoimmune gastritis and consider surveillance if used.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Background and aims

Autoimmune gastritis (AIG) is characterized by chronic hypergastrinemia and is associated with an increased risk of gastric neuroendocrine neoplasms (gNENs). Because proton pump inhibitors (PPIs) further increase gastrin secretion, concerns have been raised regarding a potential additive effect on gastric neoplastic risk. This study aimed to evaluate the association between PPI exposure and gNEN occurrence in patients with AIG using a large real-world database.

Methods

We conducted a retrospective propensity score-matched cohort study using the TriNetX Global Collaborative Network. Patients with AIG were identified using diagnostic codes for chronic atrophic gastritis or pernicious anaemia, excluding Helicobacter pylori infection, gastric cancer, multiple endocrine neoplasia or other competing gastric conditions. Two cohorts were defined: patients with AIG receiving PPIs and patients without PPI exposure. The primary outcome was the overall occurrence of gNENs. A prespecified secondary analysis excluded patients with gNENs diagnosed before the index date to evaluate incident tumours. Secondary outcomes included hypergastrinemia, intestinal metaplasia and gastric polyps.

Results

A total of 153,687 patients with AIG were identified. After 1:1 propensity score matching, 40,489 patients were included in each cohort. After propensity score matching, gNENs were recorded in 241 patients (0.60%) without PPI exposure and 360 patients (0.89%) receiving PPIs. PPI exposure was associated with a significantly higher occurrence of gNENs (risk ratio [RR] 1.49, 95% CI 1.27-1.76), which was confirmed by time-to-event analysis (hazard ratio [HR] 1.44, 95% CI 1.22-1.70; log-rank p < 0.001). The association persisted after exclusion of patients with pre-existing gNENs (RR 1.61, 95% CI 1.26-2.06; HR 1.52, 95% CI 1.19-1.95). PPI exposure was also associated with higher occurrences of hypergastrinemia (HR 1.17, 95% CI 1.00-1.37), intestinal metaplasia (HR 1.53, 95% CI 1.36-1.71) and gastric polyps (HR 2.48, 95% CI 2.25-2.73). No gastric adenocarcinomas were identified during follow-up.

Conclusions

In this large real-world propensity score-matched study, PPI exposure was associated with a greater occurrence of both overall and incident gNENs in patients with AIG. PPI use was also consistently associated with gastric mucosal alterations, including hypergastrinemia, intestinal metaplasia and gastric polyps. Although the absolute risk of gNENs remained low, these findings support judicious long-term PPI prescribing in patients with AIG and reinforce the importance of appropriate endoscopic surveillance in this high-risk population.

DOI

10.1111/apt.70954

PMID

42701999

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

Want more like this?

Browse more from the feed. A free account unlocks the full feed, saving and communities.

Back to the research feed

Create a free account · Sign in