Are histamine-2 receptor antagonists a reasonable comparator: comparing apples and apples?

Abstract

We recently read with great interest the article by Devin Abrahami et al .1 We would like to raise some concerns that warrant further discussion. The association between proton pump inhibitors (PPIs) and the risk of inflammatory bowel disease (IBD) remains a debate, the authors mostly focus on the protopathic bias introduced by study design. However, in this study, the authors used histamine-2 receptor antagonists (H2RAs) as an active comparator. While this partially balanced the bias introduced by indications, it may have masked the potential impact of PPIs on the incidence of IBD. In the general population, the age-standardised and sex-standardised incidence of IBD is 10.9 per 100 000 person-years.2 Bin Xia et al through the NHS and UK Biobank cohorts, investigated the association between PPIs and the risk of IBD, reporting …