DOI: 10.14309/ctg.0000000000000596 ISSN:

Bile acid sequestrant use and gastric cancer: A national retrospective cohort analysis

Andrew Canakis, Amy Lee, Alese E. Halvorson, Jennifer M. Noto, Richard M. Peek, Otis Wilson, Adriana Hung, Christianne L. Roumie, Robert Greevy, Shailja C. Shah
  • Gastroenterology
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Abstract

Introduction:

Bile acids have been implicated in gastric carcinogenesis. We hypothesized that bile acid sequestrant medication (BAM) use is associated with a lower gastric cancer (GC) incidence.

Methods:

We assembled a cohort of Veterans receiving longitudinal care within the Veterans Health Administration (VHA) between 2000-2020 who completed testing for H. pylori. The index date was the date of completed H. pylori testing. The primary exposure was the number of filled BAM prescription(s) in the 5 years prior to the index date. The primary outcome was incident GC, stratified by anatomic subsite. Follow-up began at the index date and ended at the earliest of GC, death, after 2 years of follow-up, or the study end (May 31, 2020). We used Kaplan-Meier curves to visualize differences in GC incidence by exposure group and multivariable Cox proportional hazards models to estimate the association between BAM exposure and anatomic site-specific GC.

Results:

Among 417,239 individuals (89% male, mean 54 years-old, 63% non-Hispanic White), 4,916 (1.2%) filled at least one BAM prescription, 2,623 of whom filled

>
4. Compared to unexposed individuals, those with
>
4 BAM fills prior to entry had a lower incidence (aHR 0.71, 95% CI, 0.37-1.36) of GC but confidence intervals were wide. Results were consistent irrespective of GC anatomic site.

Discussion:

BAMs may have a protective effect against both cardia and noncardia GC. Further research and external validation are needed to confirm these findings.

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