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A recent randomised controlled trial showed that proton pump inhibitors (PPIs), compared with histamine-2 receptor antagonists (H2RAs), induce greater gut microbiome alterations and oral-to-gut transmission, mechanisms that have been implicated in various gastrointestinal disorders, including inflammatory bowel disease (IBD).1 Although studies evaluating the association between PPIs and IBD have been conducted in adults,2 paediatric evidence remains scarce. Given the increasing global burden of IBD—particularly among children, who experience more aggressive disease and greater clinical impact3 4—together with rising PPI use in children and their vulnerability to drug toxicity,5 6 we investigated the risk of IBD associated with PPIs versus H2RAs in the paediatric population.