Studies have shown that patients continue to have gastrointestinal complications, despite intraoperative histamine 2 antagonist therapy, and that more robust prophylaxis is required [193]. A summary of the available evidence concluded that a proton-pump inhibitor, but not an histamine 2 antagonist, reduced gastrointestinal complications [194]. Indeed, a large randomized trial of 210 patients undergoing cardiac surgery randomly assigned patients to teprenone, ranitidine or rabeprazole and found that patients treated with a proton-pump inhibitor (rabeprazole) had a significantly lower rate of active ulcers (4.3%) compared with 21.4% and 28.6% in patients treated with the histamine 2 antagonist (ranitidine) and the mucosal protector (teprenone), respectively [195]. Therefore, prophylaxis with a proton-pump inhibitor should be considered, despite a concern that routine prophylaxis may increase the incidence of postoperative pneumonia [196]. Although, there is conflicting evidence to support this statement [197].
