Long-Term Proton Pump Inhibitor Therapy and Risk of Gastric Atrophy and Precancerous Mucosal Changes: A Systematic Review
Abstract
This systematic review evaluated the association between long-term use of proton pump inhibitors (acid-suppressing medications) and the development of gastric atrophy and related precancerous mucosal changes. Six clinical trials involving a total of more than 1,100 patients with acid-peptic disorders were analyzed, encompassing diverse study designs, follow-up durations ranging from two to five years, and variable Helicobacter pylori infection status. Across these studies, long-term proton pump inhibitor therapy alone did not consistently accelerate the progression of gastric atrophy or intestinal metaplasia. Three trials demonstrated stability or regression of mucosal changes following eradication of H. pylori, while two reported progression of corpus atrophy or metaplasia in patients with persistent infection; one study found minimal overall histological change regardless of therapy. Some studies noted hypergastrinemia and corpus atrophy during prolonged treatment, but these findings were inconsistent and often influenced by baseline histology and geographic variation. Collectively, the evidence underscores the importance of assessing and managing H. pylori infection in patients requiring prolonged acid suppression. The available evidence is limited by the small number of trials, modest sample sizes in some studies, and reliance on older data, highlighting the need for updated large-scale investigations.
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,100 participants or records.
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