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.

中文翻译：

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胆汁酸螯合剂的使用和胃癌：全国回顾性队列分析。

引言 胆汁酸与胃癌发生有关。我们假设胆汁酸螯合剂 (BAM) 的使用与较低的胃癌 (GC) 发病率相关。方法 我们收集了一组 2000 年至 2020 年间在退伍军人健康管理局 (VHA) 内接受纵向护理的退伍军人，他们完成了幽门螺杆菌检测。索引日期是完成幽门螺杆菌检测的日期。主要暴露是索引日期之前 5 年内已配 BAM 处方的数量。主要结局是GC事件，按解剖亚位点分层。随访从索引日期开始，最早在 GC、随访 2 年后死亡或研究结束（2020 年 5 月 31 日）结束。我们使用 Kaplan-Meier 曲线可视化不同暴露组的 GC 发生率差异，并使用多变量 Cox 比例风险模型来估计 BAM 暴露与解剖部位特异性 GC 之间的关联。结果 在 417,239 名个体中（89% 为男性，平均年龄 54 岁，63% 为非西班牙裔白人），4,916 人（1.2%）至少配了一份 BAM 处方，其中 2,623 人配了 > 4 份处方。与未暴露的个体相比，进入前 BAM 填充量大于 4 的个体的 GC 发生率较低（aHR 0.71，95% CI，0.37-1.36），但置信区间较宽。无论 GC 解剖部位如何，结果都是一致的。讨论 BAM 可能对贲门和非贲门 GC 具有保护作用。需要进一步的研究和外部验证来证实这些发现。