PMID- 36819375
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230224
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 1
DP  - 2023 Jan
TI  - Effectiveness of Proton Pump Inhibitor Therapy in the Prevention of Bleeding 
      After Prophylactic Endoscopic Variceal Band Ligation.
PG  - e33932
LID - 10.7759/cureus.33932 [doi]
LID - e33932
AB  - Background Endoscopic variceal ligation (EVL) is a surgical intervention that can 
      work well to curb variceal bleeding in people with liver cirrhosis. However, it 
      could make ulcer bleeding worse and be fatal in some cases. The widespread use of 
      proton pump inhibitors (PPI) in cirrhotic individuals with variceal bleeding is 
      empirical rather than based on scientific data. According to many studies, PPIs 
      reduce the size of post-EVL ulcers. This study aimed to see if PPI use could 
      reduce rebleeding after endoscopy therapy in cirrhotic patients with variceal 
      bleeding. Methodology A retrospective cross-sectional study was conducted at a 
      tertiary care hospital from August 2019 to September 2021. Cirrhotic patients 
      with bleeding gastroesophageal varices (GEVs) who had undergone EVL at the same 
      hospital were enrolled in the study. Medical records were organized, and the 
      sample was divided into two groups based on whether or not PPI was given. Both 
      PPI and non-PPI patients had their endoscopic findings, initial hemostasis 
      outcomes, rebleeding rates, bleeding-related mortality rates, and 
      treatment-related comorbidities compared. Results A total of 46 patients were 
      selected for the study and divided into two groups (PPI group n=28 and non-PPI 
      group n=18). The majority of the patients were males. The PPI group had a mean 
      age of 58.6 +/-7.8 years, whereas the non-PPI group had a mean age of 53.6 +/-4.4 
      years. Hepatitis B virus (HBV) infection was the most prevalent cause of 
      cirrhosis in both groups. After endoscopic treatment, three patients (16%) in the 
      non-PPI group suffered a variceal hemorrhage. Bleeding-related fatalities and the 
      time it took for the bleeding to stop varied significantly between the two 
      groups. History of variceal bleeding (relative risk (RR)=1.45; 95% confidence 
      interval (CI), 1.60-7.67; p=0.02), presence of gastric varices (RR=2.23; 95% CI, 
      2.56-9.832; p=0.035), and not administering PPIs (RR =7.542; 95% CI, 3.98-29.13; 
      p=0.008) were linked with rebleeding. The presence of red concurrent esophageal 
      varices (RR=6.37; 95% CI, 0.562-15.342; p=0.002) and failure to provide PPIs 
      (RR=2.3; 95% CI, 1.621-25.64; p=0.04) were linked with post-EVL bleeding in a 
      multivariate analysis. Conclusions Proton pump inhibitors reduce the occurrence 
      of early bleeding and adverse events after EVL in cirrhotic patients. Not 
      prescribing PPIs and the presence of GEVs were substantially related to a higher 
      risk of bleeding during preventative EVL. Not initiating PPI medication 
      immediately was the sole predictor of bleeding complications in patients who had 
      undergone EVL without gastric varix treatment. To lower the risk of post-EVL 
      ulcer bleeding, we recommend PPI use in patients undergoing EVL.
CI  - Copyright (c) 2023, Khawaja et al.
FAU - Khawaja, Imran
AU  - Khawaja I
AD  - Internal Medicine, Ayub Teaching Hospital, Abbottabad, PAK.
FAU - Babar, Muhammad
AU  - Babar M
AD  - Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
FAU - Awan, Shakeel Ahmad
AU  - Awan SA
AD  - Medicine, University Hospitals of Derby and Burton, Burton, GBR.
FAU - Shaikh, Asif J
AU  - Shaikh AJ
AD  - Nephrology, Zayed Military Hospital, Abu Dhabi, ARE.
FAU - Abbasi, Adnan A
AU  - Abbasi AA
AD  - Family Medicine, Musgrove Park Hospital, Taunton, GBR.
LA  - eng
PT  - Journal Article
DEP - 20230118
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9937675
OTO - NOTNLM
OT  - evl
OT  - gastroesophageal varices
OT  - gv bleeding
OT  - liver cirrhosis
OT  - ppi
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/02/24 06:00
MHDA- 2023/02/24 06:01
PMCR- 2023/01/18
CRDT- 2023/02/23 10:02
PHST- 2023/01/18 00:00 [accepted]
PHST- 2023/02/23 10:02 [entrez]
PHST- 2023/02/24 06:00 [pubmed]
PHST- 2023/02/24 06:01 [medline]
PHST- 2023/01/18 00:00 [pmc-release]
AID - 10.7759/cureus.33932 [doi]
PST - epublish
SO  - Cureus. 2023 Jan 18;15(1):e33932. doi: 10.7759/cureus.33932. eCollection 2023 
      Jan.