Chronic proton-pump inhibitor (PPI) exposure ≥10 years (omeprazole, esomeprazole, pantopr...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-GASTRIC`
Sources	`SRC-NCCN-GASTRIC-2025` `SRC-NCCN-NET-2025`

Red Flag Origin

Definition	Chronic proton-pump inhibitor (PPI) exposure ≥10 years (omeprazole, esomeprazole, pantoprazole, lansoprazole, rabeprazole, dexlansoprazole). Sustained acid suppression → hypergastrinemia → enterochromaffin-like (ECL) cell hyperplasia in gastric body / fundus mucosa → small but measurable elevation in well-differentiated Type-1 gastric neuroendocrine tumors (gastric NET, formerly gastric carcinoid). Concomitantly, chronic acid suppression accelerates progression of underlying atrophic gastritis (especially in H. pylori-positive cohort) — atrophic gastritis is itself an independent gastric adenocarcinoma risk factor. Absolute risk increment is modest (most long-term PPI users do NOT develop gastric NET or cancer) but the cohort is large (millions exposed) and the indication for PPI is often weak (long-tail use for vague dyspepsia, NSAID prophylaxis without ongoing NSAID use, post-hospital...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "ppi_continuous_use_ge_10y",
      "value": true
    },
    {
      "finding": "ppi_chronic_use_with_atrophic_gastritis",
      "value": true
    },
    {
      "finding": "ppi_chronic_use_with_hypergastrinemia",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for chronic PPI exposure ≥10y. Engine routes to PreventionPlan recommending (1) indication-review + de-prescription where the PPI is no longer needed (most common scenario), (2) fasting gastrin + chromogranin A in cohort with persistent acid-suppression indication, (3) EGD with body/fundus biopsies in those with elevated gastrin or symptoms; surveillance EGD q3-5y if atrophic gastritis or ECL hyperplasia documented. Anchored to DIS-GASTRIC (gastric NET and atrophic-gastritis-derived adenocarcinoma both gastric-body diseases); NET-specific outcomes carried in indication prose. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-OBSERVATION - IND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-OBSERVATION
IND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-SURVEILLANCE - IND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-SURVEILLANCE