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Proton-pump inhibitors are associated with a high false-positivity rate in faecal immunochemical testing

  • Original Article—Alimentary Tract
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Abstract

Background

False-positivity rates in faecal immunochemical test (FIT) can be affected by drug exposure. We aimed to assess the association between proton pump inhibitors (PPI) consumption and false positive (FP) results in a colorectal cancer (CRC) screening programme using electronic prescription records.

Methods

A retrospective cohort study within a population-based screening program for CRC from 2010 to 2016 was performed. Participants with a conclusive FIT result and with prescription electronic data were included. An FP result was defined as having a positive FIT (≥ 20 µg haemoglobin/g faeces) and a follow-up colonoscopy without intermediate or high-risk lesions or CRC. Screening data were anonymously linked to the public data analysis program for health research and innovation (PADRIS) database that recorded patient diseases history and reimbursed medication. PPI exposure was defined as having retrieved at least one dispensation of PPI three months prior to the FIT.

Results

A total of 89,199 tests (of 46,783 participants) were analysed, 4824 (5.4%) tested positive and the proportion of FP was 53.5%. Overall, 17,544 participants (19.7%) were PPI users prior to FIT performance. PPI exposure increased the probability of obtaining an FP FIT result from 50.4 to 63.3% (adjusted OR 1.39; 95% CI 1.18–1.65). Nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, antibiotics, and laxatives were also associated with an FP result. The effect of PPI was independent and showed a synergistic interaction with nonsteroidal anti-inflammatory drugs.

Conclusion

PPIs increase FIT positivity at the expense of FP results. The recommendation to avoid their use before FIT performance could reduce up to 3% of colonoscopies and 9% of FP results.

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Abbreviations

BMI:

Body mass index

CRC:

Colorectal cancer

gFOBT:

Guaiac-based faecal occult blood test

GI:

Gastrointestinal

FP:

False positive

FIT:

Faecal immunochemical test

NSAID:

Nonsteroidal anti-inflammatory drugs

PPI:

Proton pump inhibitor

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Acknowledgements

We would like to thank Elisenda Martinez and to the Public Data Analysis for Health Research and Innovation Program (PADRIS) for their administrative and statistical support. We thank CERCA Program, Generalitat de Catalunya for institutional support.

Funding

This study was partially cofunded by the Carlos III Health Institute, the European Regional Development Fund—a way to build Europe- (PI12/00992, PI14-00613, PI16/00588, PI17-00092) and by the Department of Universities and Research (2017 SGR 723; 2017 SGR 1283) of the Government of Catalonia. Also the Spanish Association Against Cancer (AECC) Scientific Foundation.

Author information

Authors and Affiliations

  1. Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology, Avinguda Gran Via, 199-203, 08908, L’Hospitalet de Llobregat, Barcelona, Spain

    Gemma Ibáñez-Sanz, Luisa C. de la Peña-Negro & Victor Moreno

  2. Gastroenterology Department, Bellvitge University Hospital, Carrer Feixa Llarga s/n., 08908, L’Hospitalet de Llobregat, Barcelona, Spain

    Gemma Ibáñez-Sanz, Luisa C. de la Peña-Negro, Lorena Rodríguez-Alonso & Francisco Rodríguez-Moranta

  3. Colorectal Cancer Research Group, ONCOBELL Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain

    Gemma Ibáñez-Sanz & Victor Moreno

  4. CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Gemma Ibáñez-Sanz, Montse Garcia, Gemma Binefa, Francisco Rodríguez-Moranta & Victor Moreno

  5. Cancer Screening Unit, Prevention and Control Programme, Catalan Institute of Oncology, L’Hospitalet de Llobregat, Barcelona, Spain

    Núria Milà, Montse Garcia, Carmen Vidal & Gemma Binefa

  6. Early Detection of Cancer Research Group, EPIBELL Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain

    Núria Milà, Montse Garcia, Carmen Vidal & Gemma Binefa

  7. Gastroenterology Department, Viladecans Hospital, Viladecans, Spain

    Luisa C. de la Peña-Negro

  8. Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain

    Victor Moreno

Authors
  1. Gemma Ibáñez-Sanz
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  9. Victor Moreno
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Contributions

VM and FR are the guarantors. GI, FR and VM participated in the study design; GI and NM performed the analysis; GI, MG, FR and VM interpreted the data; GI and LP wrote the report; and all the authors agreed to submit the article for publication. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding authors

Correspondence to Francisco Rodríguez-Moranta or Victor Moreno.

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Ibáñez-Sanz, G., Milà, N., de la Peña-Negro, L.C. et al. Proton-pump inhibitors are associated with a high false-positivity rate in faecal immunochemical testing. J Gastroenterol 56, 42–53 (2021). https://doi.org/10.1007/s00535-020-01738-z

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  • DOI: https://doi.org/10.1007/s00535-020-01738-z

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