e C. difficile cells had only marginal survival in gastric contents at low pH; adjustment to a pH
of >5 resulted in survival similar to that in the phosphate-buffered saline control. The survival of
vegetative C. difficile in gastric contents obtained from patients receiving PPIs was also increased at a pH
of >5. The ability of the vegetative form of C. difficile to survive on moist surfaces and in gastric contents
with an elevated pH suggests a potential mechanism by which PPI therapy could increase the risk of
acquiring C. difficile