Use of proton pump inhibitors and risk of pancreatic cancer

Pharmacoepidemiol Drug Saf. 2018 Aug;27(8):926-930. doi: 10.1002/pds.4576. Epub 2018 Jun 20.


Purpose: Preclinical studies have suggested that proton pump inhibitors (PPIs) may increase pancreatic cancer risk; however, epidemiological studies are few, with conflicting results. This spurred us to evaluate whether PPI use is associated with an increased risk of pancreatic cancer in a large population-based study.

Methods: We conducted a nationwide case-control study using data from Danish demographic and health care registries. All patients with a first cancer diagnosis of pancreatic cancer between 2000 and 2015 were identified from the Danish Cancer Registry and age-matched, sex-matched, and calendar-matched 1:20 to population controls using risk set sampling. Conditional logistic regression was applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for pancreatic cancer associated with PPI use, adjusting for potential confounders. Secondary analyses examined dose-response patterns and associations with individual PPIs as well as with histamine-2-receptor antagonists.

Results: Ever use of PPIs occurred among 27.8% of 6921 pancreatic cancer cases and 25.4% of 34 695 matched controls, yielding a neutral adjusted OR of 1.04 (95% CI 0.97-1.11). Odds ratios were also close to unity in analyses of high use of PPIs (≥1000 DDDs; OR, 0.92 95% CI 0.80-1.07). There was no evidence of a dose-response relationship, with ORs close to unity across categories, including for those with the highest cumulative use (>2000 DDDs; OR, 1.03 95% CI 0.84-1.26). Analyses of subgroups as well as individual types of PPI and of histamine-2-receptor antagonists use also returned neutral associations.

Conclusions: In this large nationwide case-control study, PPI use was not associated with an increased risk of pancreatic cancer.

Keywords: pancreatic cancer; pharmacoepidemiology; proton pump inhibitors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Case-Control Studies
  • Denmark / epidemiology
  • Dose-Response Relationship, Drug
  • Female
  • Gastroesophageal Reflux / drug therapy*
  • Histamine H2 Antagonists / administration & dosage
  • Histamine H2 Antagonists / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / chemically induced
  • Pancreatic Neoplasms / epidemiology*
  • Proton Pump Inhibitors / administration & dosage
  • Proton Pump Inhibitors / adverse effects*
  • Registries / statistics & numerical data
  • Risk Factors


  • Histamine H2 Antagonists
  • Proton Pump Inhibitors