Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial

Hidaka, Hiroyoshi; Nakazawa, Takahide; Wang, Guoqin; Kokubu, Shigehiro; Minamino, Tsutomu; Takada, Juichi; Tanaka, Yoshiaki; Okuwaki, Yusuke; Watanabe, Masaaki; Tanabe, Satoshi; Shibuya, Akitaka; Koizumi, Wasaburo

doi:10.1007/s00535-011-0472-0

Cited by 47 publications

(60 citation statements)

References 21 publications

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“…Nijhawan et al observed that 60% of post-EVL ulcers were healed within 2 weeks and 100% were healed within 3 weeks [26]. Although numerous studies demonstrate that PPIs effectively reduce post-procedure ulcer size and accelerate ulcer healing, none have demonstrated altered rebleeding or mortality rates in patients with post-treatment EV bleeding [15–17, 27]. The explanation provided was that most rebleeding events arise from varices rather than ulcers, and therefore the value of PPI use was questioned.…”

Section: Discussionmentioning

confidence: 99%

The Role of Adjuvant Acid Suppression on the Outcomes of Bleeding Esophageal Varices after Endoscopic Variceal Ligation

Liang

Hsu

et al. 2017

PLoS ONE

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The impact of adjuvant acid suppression via proton pump inhibitors or histamine-2 receptor antagonists after endoscopic variceal ligation remains uncertain. We therefore aimed to evaluate the effect of adjuvant acid suppression on the rebleeding and mortality rates in patients who received endoscopic variceal ligation and vasoconstrictor therapy for bleeding esophageal varices. Data from 1997 to 2011 were extracted from the National Health Insurance Research Database in Taiwan. A total of 1576 cirrhotic patients aged > 18 years with a primary diagnosis of acute esophageal variceal bleeding who received endoscopic variceal ligation therapy were screened. After strict exclusion, 637 patients were recruited. The exclusion criteria included patients with gastric variceal bleeding, failure in the control of bleeding, mortality within 12 hours, and history of hepatocellular carcinoma or gastric cancer. Patients were divided into two groups: the vasoconstrictors group (n = 126) and vasoconstrictors plus acid suppression group (n = 511). We observed that the rebleeding and mortality rates were not significantly different between 2 groups during hospitalization and the 15-year follow-up period after discharge. A Charlson score ≥3 (odds ratio: 2.42, 95% confidence interval: 1.55 ~3.79, P = 0.0001), presence of hepatitis C virus (odds ratio: 1.70, 95% confidence interval: 1.15 ~2.52, P = 0.0085), and cirrhosis (odds ratio: 1.69, 95% confidence interval: 1.08 ~2.66, P = 0.0229) were the independent risk factors of mortality after discharge. In conclusion, the results of the current study suggest that adjuvant acid suppression prescription to patients who received endoscopic variceal ligation and vasoconstrictor therapy for bleeding esophageal varices may not change the rebleeding and mortality outcomes compared to that for those who received endoscopic variceal ligation and vasoconstrictor agents without acid suppression.

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Section: Discussionmentioning

confidence: 99%

The Role of Adjuvant Acid Suppression on the Outcomes of Bleeding Esophageal Varices after Endoscopic Variceal Ligation

Liang

Hsu

et al. 2017

PLoS ONE

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“…In a study by Tzathas et al [37], the authors suggested that H. pylori eradication does not protect all cirrhotics from ulcer recurrence and the majority of ulcers recur in H. pylori negative patients; therefore, omeprazole maintenance treatment is mandatory, irrespectively of H. pylori status. In addition there are data to support acid suppression therapy in the treatment of post-banding ulcers [8,38]. …”

Section: Discussionmentioning

confidence: 99%

Bacterial load and cytokine profile in patients with cirrhosis following therapy with proton pump inhibitors: a prospective cohort study

Triantos¹,

Kalafateli²,

Spantidea

et al. 2017

aog

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BackgroundThe aim of this study was to explore the presence of bacterial products and the cytokine profile in outpatients with cirrhosis before and after short-term (4-8 weeks) administration of proton pump inhibitors (PPIs).MethodsSeventeen patients with cirrhosis—male/female: 12/5; age: median 59.2 years (49-65); etiology: HBV±HDV 23.5%, HCV 17.7%, alcohol 41.2%, other 17.6%; Child-Pugh score: median 7.5 (5-12); Model for End-stage Liver Disease: 10.5 (7-21); ascites (%): 3 (17.7)—attending the outpatient clinics were included. None had hepatocellular carcinoma. Indications for PPIs were: esophagitis (n=6, 35.3%), peptic ulcer (n=10, 58.6%) and other (n=1, 5.9%). Bacterial DNA in serum and the levels of endotoxin, lipopolysaccharide binding protein, transforming growth factor-β, interleukin -1β, -6, -8, -12, -10, tumor necrosis factor-α and nitric oxide were assessed at baseline (time 1) and at the end of treatment (time 2). The Wilcoxon signed rank test was used to evaluate significant differences in the parameters assayed before and after PPI administration.ResultsNo patients developed infection during the study period. Bacterial DNA was not detected before or after treatment. No significant differences were observed between the concentrations of any indices between times 1 and 2 (P>0.05). Subgroup analysis according to Child-Pugh stage yielded similar results.ConclusionShort-term administration of PPIs had no effect on bacterial DNA, bacterial products or cytokine concentrations in patients with liver cirrhosis.

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“…However, the subjects (n = 21 and 22 in the rabeprazole and placebo groups, respectively) were included only after endoscopic statement of post-EVL ulcer healing; so the PPI effect on active post-banding ulcers was not evaluated. [31] In 2013, another randomized controlled study compared 5 days of intravenous PPI (pantoprazole 40 mg or omeprazole 40 mg) versus intravenous vasoconstrictors (somatostatin 250 mg/h or terlipressin 1 mg/6 h) after EVL in 118 individuals with cirrhosis and acute variceal bleeding. The number and the width of the esophageal ulcers were higher in the vasoconstrictor group than in the PPI group, but no significant difference in esophageal ulcer bleeding was found between the treatments.…”

Section: Risk Factorsmentioning

confidence: 99%

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

Lima

Silva

Romeiro

2018

CRIM

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Esophageal varices develop in half of cirrhotic patients. Endoscopic variceal band ligation is the current treatment for acute bleeding and applicable for primary and secondary prophylaxis. However, there is a risk of complications, including ligationinduced ulcer bleeding. The aim of this study is to review the current diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band-ligation ulcers in cirrhotic patients. PubMed and Google Scholar were searched for English language articles about the theme. The main findings were that Child-Pugh class C, higher model of end-stage liver disease, emergency ligation, presence of hepatocellular carcinoma, peptic esophagitis and bacterial infection were reported as the most important risk factors for post-banding ulcer hemorrhage. There are few studies with proton pump inhibitors and sucralfate showing size reduction of post-banding ulcers. Many treatment modalities have been used to control post band ulcer bleeding, such as band local injection of epinephrine or cyanoacrylate, balloon tamponade, stent placement and ligation of the ulcerated bleeding site. However, the optimal management remains uncertain. The principal conclusions of the study were that post-banding ulcer bleeding is potentially life-threatening and must be suspected in the presence of hematemesis, melena or anemia after endoscopic variceal band ligation (EVL). Predictors of rebleeding must be assessed and controlled as much as possible before band ligation. The post-banding treatment with proton pump inhibitors or sucralfate seems advisable, in particular for high-risk patients. Further investigation and new approaches are still required to achieve optimal management of this complication.

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Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial

Abstract: Long-term administration of PPIs reduced the risk of treatment failure after EVL. Acid suppression therapy should also be considered as a treatment option after EVL.

Cited by 47 publications

References 21 publications

The Role of Adjuvant Acid Suppression on the Outcomes of Bleeding Esophageal Varices after Endoscopic Variceal Ligation

The Role of Adjuvant Acid Suppression on the Outcomes of Bleeding Esophageal Varices after Endoscopic Variceal Ligation

Bacterial load and cytokine profile in patients with cirrhosis following therapy with proton pump inhibitors: a prospective cohort study

Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients

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