PDF(Pubmed)
Abstract：
Sporadic fundic gland polyps (FGPs) progress, albeit rarely, to dysplasia and cancer. Two meta-analyses, including 8 and 11 studies, concluded that proton pump inhibitors (PPIs) were associated with FGPs. Intervention is considered unnecessary when FGPs have a background of PPIs use. Both meta-analyses, however, disregarded known confounders: age, sex, endoscopy indications, study design (prospective or retrospective), duration of PPI use, and H. pylori infection. Confounders are known to invalidate meta-analyses. We followed PRIXMA guidelines and searched the literature for studies on FGPs in PPI-users and PPI-nonusers. In the 22 studies searched, we compared FGPs in PPI-users (n = 6534) and PPI-nonusers (n = 41 115). Heterogeneity was significant (Cochran Q = 277.8, P < 0.0001; I2 = 92.8%), annulling meta-analysis performed by blanket tallying. To offset the above confounders, we matched PPI-users and PPI-nonusers by (a) age and sex (n = 4300 and 29 307, respectively) and (b) their propensity scores derived from the confounders (n = 2950 and 4729, respectively). After both matching, FGPs were not significantly different between PPI-users and PPI-nonusers [odds ratio (OR) = 1.1, P = 0.3078; OR = 0.9, P = 0.3258, respectively]. Furthermore, FGP frequency did not correlate with increasing duration of PPI use (Pearson and Spearman correlation coefficients = 0.1162, 0.0386, P < 0.6064, 0.8646, respectively); it was not significantly different between any of the duration periods of observation, namely, <10, 10-20, 20-40, >40 months, nor was it significantly different between PPI-users and PPI-nonusers within each duration period (P > 0.05). We conclude that PPIs are not associated with FGPs, implying that a background history of PPI use is not a justification for nonintervention in the management of FGPs.
摘要：
散发性胃底腺息肉（FGPs）进展，虽然很少,发育不良和癌症。两个荟萃分析，包括8和11项研究，结论质子泵抑制剂（PPI）与FGPs相关。当FGP具有PPI使用背景时，干预被认为是不必要的。两项荟萃分析，然而,忽视已知的混杂因素：年龄，性别,内窥镜检查适应症,研究设计（前瞻性或回顾性），PPI使用的持续时间，和幽门螺杆菌感染。众所周知，混杂因素会使荟萃分析无效。我们遵循PRIXMA指南，并在文献中搜索了PPI使用者和非PPI使用者中FGP的研究。在搜索的22项研究中，我们比较了PPI使用者(n=6534)和非PPI使用者(n=41115)的FGP。异质性显著(CochranQ=277.8,P<0.0001;I2=92.8%),无效的荟萃分析通过毯子计数进行。为了抵消上述混杂因素，我们通过(a)年龄和性别(分别为n=4300和29307)和(b)来自混杂因素的倾向评分(分别为n=2950和4729)对PPI使用者和非PPI使用者进行了匹配.两者匹配后，PPI使用者和非PPI使用者之间的FGPs没有显着差异[比值比（OR）=1.1，P=0.3078；OR=0.9，P=0.3258]。此外，FGP频率与PPI使用持续时间的增加不相关（Pearson和Spearman相关系数分别=0.1162、0.0386，P<0.6064、0.8646）；在观察的任何持续时间之间都没有显着差异，即,<10,10-20,20-40,>40个月,PPI使用者和非PPI使用者在每个持续时间内也没有显著差异(P>0.05).我们得出结论，PPI与FGP无关，暗示PPI使用的背景历史并不是不干预FGPs管理的理由。
