Proton-Pump Inhibitors vs. Histamine-2 Receptor Antagonists to Prevent Stress Gastritis

Critically ill patients are at risk for developing gastrointestinal bleeding (GIB) from stress-related mucosal disease. Prophylactic acid reduction therapy using either proton-pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) is common. However, acid reduction is associated with an increased risk for pneumonia and has been suggested to increase the risk for Clostridium difficile infection (CDI; NEJM JW Gastroenterol Nov 12 2013, NEJM JW Gen Med Jul 31 2012, NEJM JW Gastroenterol Dec 23 2013).

To compare frequencies of GIB, pneumonia, and CDI associated with PPI use versus H2RA use in this setting, investigators retrospectively reviewed patient data from a commercial administrative database. Study patients required mechanical…