The Efficacy of Proton Pump Inhibitor in Cirrhotics with Variceal Bleeding: A Systemic Review and Meta-Analysis

Abstract

Background and Aims: Proton pump inhibitor (PPI) was widely used in cirrhotic patients with variceal bleeding empirically rather than evidence-based practice. We aimed to evaluate the plausible indication of PPI use in variceal bleeding cirrhotic patients and figure out whether it can decrease the re-bleeding rate after endoscopic therapy. Furthermore, we also investigated the association between PPI and bleeding-related mortality in these patients. Methods: We have searched in PubMed, Medline, Web of Science, Google Scholar, Cochrane and Embase prior to May 2019. Pooled OR and 95% CI were calculated by random-effects model. Results: A total of 11 original articles including 1,818 cirrhotic patients were analyzed. The overall meta-analysis highlighted that PPI use may decrease the re-bleeding rate after endoscopic therapy (OR 0.52, 95% CI 0.35–0.77). The conclusion was irrespective of study methods, endoscopic purpose and hemorrhage sites. However, the conclusion speculated that PPI should be prescribed >1 month. Meanwhile, PPI use may not impact the bleeding-related mortality. Conclusions: PPI, used for >1 month, can decrease re-bleeding rate after endoscopic therapy in cirrhotic patients for prophylaxis or emergency treatment purpose. No matter how long it takes, PPI use is not associated with bleeding-related mortality.

Bleeding from band ligation-induced ulcers following the treatment of oesophageal varices: a retrospective case–control study.

“…In our results, the use of PPIs was associated with a reduced risk of post-BL ulcer bleeding (odds ratio, 0.77; 95% CI: 0.603-0.983). This nding is in agreement with those of several other studies [13,19]. The use of PPIs to reduce the size of an ulcer and lower the risk of re ux oesophagitis and post-prophylactic BL bleeding has been established [12,20].…”

“…alcoholic liver disease, nonalcoholic fatty liver disease, viral, alcoholic liver disease plus viral, autoimmune liver disease or other), haemostasis treatment urgency (i.e. elective or emergent) and adjuvant use of PPIs [12,13]. The other categorical variables included high-risk stigmata (i.e.…”

Efficacy and Safety of Ligation Combined With Sclerotherapy for Patients With Acute Esophageal Variceal Bleeding in Cirrhosis: A Meta-Analysis

“…EVB is the main influencing factor for the increased mortality in patients with liver cirrhosis ( 3 ). The mortality of the first bleeding was about 20–30% if an active intervention was not carried out ( 4 ). Within 2 years after the first bleeding, the rebleeding rate and mortality increased significantly, which threatened the safety of patients ( 5 ).…”

The impact of proton pump inhibitors in liver diseases and the effects on the liver

“…[5][6][7] About 46%-78% of the patients with cirrhosis have been treated with acid suppression therapy, as it may be associated with a reduction in gastrointestinal rebleeding in cirrhotic patients. 8,9 Inappropriate and prolonged use of PPIs in cirrhosis may lead to increased complications. Studies have shown that PPIs are associated with an increased incidence of serious complications such as spontaneous bacterial peritonitis (SBP) and hepatic encephalopathy (HE) in cirrhotic patients, [10][11][12] which may be due to an elevated pH value in the gastrointestinal tract that causes dysbiosis.…”

“…The prevalence of chronic liver disease has been constantly increasing worldwide, in particular in Western countries, and liver cirrhosis is the twelfth leading cause of death globally 5–7 . About 46%–78% of the patients with cirrhosis have been treated with acid suppression therapy, as it may be associated with a reduction in gastrointestinal rebleeding in cirrhotic patients 8,9 . Inappropriate and prolonged use of PPIs in cirrhosis may lead to increased complications.…”