Effect of long-term proton pump inhibitor administration on gastric mucosal atrophy: A meta-analysis

Saudi J Gastroenterol. 2017 Jul-Aug;23(4):222-228. doi: 10.4103/sjg.SJG_573_16.


Background/aims: Proton pump inhibitors (PPIs) are widely used for the treatment of acid-related gastrointestinal diseases. Recently, some studies have reported that PPIs can alter the gastric mucosal architecture; however, the relationship remains controversial. This meta-analysis study was designed to quantify the association between long-term PPI administration and gastric atrophy.

Materials and methods: A PubMed search was conducted to identify studies using the keywords proton pump inhibitors or PPI and gastric atrophy or atrophic gastritis; the timeframe of publication searched was up to May 2016. Heterogeneity among studies was tested with the Q test; odds ratios (OR) and 95% confidence intervals (CI) were calculated. P values were calculated by I2 tests and regarded as statistically significant when <0.05.

Results: We identified 13 studies that included 1465 patients under long-term PPI therapy and 1603 controls, with a total gastric atrophy rate of 14.50%. There was a higher presence of gastric atrophy (15.84%; statistically significant) in PPI group compared to the control group (13.29%) (OR: 1.55, 95% CI: 1.00-2.41).

Conclusions: The pooled data suggest that long-term PPI use is associated with increased rates of gastric atrophy. Large-scale multicenter studies should be conducted to further investigate the relationship between acid suppressants and precancerous diseases.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review

MeSH terms

  • Atrophy / chemically induced
  • Atrophy / pathology*
  • Gastric Mucosa / drug effects
  • Gastric Mucosa / pathology
  • Gastritis, Atrophic / chemically induced*
  • Gastritis, Atrophic / epidemiology
  • Gastrointestinal Diseases / drug therapy
  • Gastrointestinal Diseases / pathology
  • Helicobacter pylori / drug effects
  • Humans
  • Incidence
  • Proton Pump Inhibitors / administration & dosage
  • Proton Pump Inhibitors / adverse effects
  • Proton Pump Inhibitors / therapeutic use*


  • Proton Pump Inhibitors