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Questions on PPIs, risk, and stress

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ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

Questions on PPIs, risk, and stress

Post by ankiwo72 »

Dear Helico expert,

In the news this past year there have been many articles revolving around the risks of long-term PPI use. Hypothetically speaking, if someone (like me or anyone else here) were infected with an uncurable H. Pylori strain, is it better for that person to go on long-term PPI use which can increase gastric cancer risk (and other health issues), or not to treat with PPIs and increase gastric cancer risk from untreated gastritis/chronic inflammation? In other words, which is the lesser of the evils/risks?

https://www.cardiovascularbusiness.com/ ... ach-cancer
https://www.health.harvard.edu/diseases ... ach_cancer
https://www.litigationandtrial.com/prot ... ch-cancer/
https://www.ncbi.nlm.nih.gov/pubmed/29852782
"It is likely that hypergastrinemia is the pathogenic factor for gastric carcinogenesis due to PPI. PPI are the only group of drugs that causes long-term hypergastrinemia in the doses used in a clinical setting. Due to the likely carcinogenic effect, PPIs should be used carefully. Moreover, since the carcinogenic effect of Helicobacter pylori (Hp) infection also may be mediated by an increase in gastrin, Hp should be eradicated whenever treatment with PPI is initiated."

Also, I have been recently coming across articles stating that stress can also cause ulcers and gastric cancer independent of H.Pylori infection:
https://www.gastrojournal.org/article/S ... 0174-7/pdf
https://www.cghjournal.org/article/S154 ... 7/fulltext

Would this affect H.Pylori's status as being the primary cause of these diseases?

Thanks in advance!

Helico_expert
Site Admin
Posts: 3637
Joined: Wed Mar 02, 2011 7:20 am

Re: Questions on PPIs, risk, and stress

Post by Helico_expert »

Good question.

gastric cancer is indeed associated with low acid level. So perhaps long term PPI does lead to higher risk of gastric cancer. Then again, without the use of PPI, patients would suffer from reflux symptoms which ultimately can lead to throat cancer or corroded teeth.

In addition, many of those gastric cancer patients have record of HP infection previously. So it is most probably that HP planted the seed of gastric cancer, not PPI. Patients with reflux symptoms without previous HP infection has very low or no gastric cancer risk.

finally, what is the definition of long term? we have patients who take PPI for decades without problem. So, I think the important message is
1. if you have reflux symptoms, you should take PPI to prevent throat cancer.
2. It is absolutely crucial to have HP eradicated to prevent the gastric cancer seed.
3. if your reflux symptoms cannot go away after a few years of PPI, it's ok. just keep going, as long as you are free of HP.

********************************
stress can definitely induce HP like symptoms.
In Australia, HP prevalence is only 15%.
Patients with gastric symptoms who visited the GP, only 20% is HP related. 80% of those HP like symptoms are caused by something else.

In one of our double blind clinical trials where volunteers were given either live HP or placebo, one volunteers ended up in emergency in the middle of the night because of stress and anxiety. At the end of the trial, we found out that he was from the placebo group.

ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

Re: Questions on PPIs, risk, and stress

Post by ankiwo72 »

Thank you that was incredibly helpful and informative!

I am scheduled to redo the endoscopy next week for antibiotic susceptibility testing. I will only go if it is confirmed my insurance will cover the procedure so soon after the last one that was a month ago.

I will keep you posted!

Helico_expert
Site Admin
Posts: 3637
Joined: Wed Mar 02, 2011 7:20 am

Re: Questions on PPIs, risk, and stress

Post by Helico_expert »

Wish you all the best and happy new year.

ankiwo72
Posts: 73
Joined: Fri May 17, 2019 2:45 am

Re: Questions on PPIs, risk, and stress

Post by ankiwo72 »

Merry Christmas and Happy New Year to you too!

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