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

  • Original Article—Alimentary Tract
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Abstract

Background and purpose

Elective esophageal variceal ligation (EVL) is performed to decrease the risk of variceal hemorrhage. EVL is associated with adverse effects, including post-ligated bleeding, chest pain, and dysphagia. Proton pump inhibitors (PPIs) are the most potent pharmacological agents for inhibition of gastric acid secretion. However, the long-term effect of PPIs after EVL remains unclear. The aim of this study was to assess the efficacy of rabeprazole, a PPI, after variceal eradication by EVL.

Methods

We performed a randomized, controlled trial in Kitasato University East Hospital. The primary endpoint was treatment failure, defined as variceal hemorrhage or severe medical complications. Between July 2007 and September 2010, 43 patients were randomized into this study and followed up until September 2010.

Results

Twenty-one patients in the rabeprazole arm received 10 mg rabeprazole daily after EVL, and 22 patients in the control received no antisecretory treatment from the same stage. Baseline characteristics did not differ between the groups (median Child-Pugh score, 6; median age, 62 years; median follow-up, 18.7 months). The trial was stopped early after an interim analysis showed that the risk of bleeding and failure of rabeprazole treatment was lower than that of no antisecretory treatment with the log-rank test showing a significant difference between the groups (P = 0.007) and a hazard ratio of 0.098 [95% confidence interval, 0.012–0.79 (P = 0.029)].

Conclusions

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.

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Abbreviations

EVL:

Endoscopic variceal ligation

PPI:

Proton pump inhibitor

HVPG:

Hepatic venous pressure gradient

ARB:

Angiotensin II type 1 receptor blocker

HCC:

Hepatocellular carcinoma

ITT:

Intention-to-treat

SD:

Standard deviation

HR:

Hazard ratio

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Acknowledgments

The authors thank the radiologists of Kitasato University East Hospital for their technical assistance. We also thank Robert E. Brandt (Founder, CEO, and CME, MedEd, Japan) for editing the manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Internal Medicine, Kitasato University East Hospital, 2-1-1 Asamizodai, Minami-ku, Sagamihara, Kanagawa, 252-0380, Japan

    Hisashi Hidaka, Takahide Nakazawa, Tsutomu Minamino, Juichi Takada, Yoshiaki Tanaka, Yusuke Okuwaki, Masaaki Watanabe, Satoshi Tanabe, Akitaka Shibuya & Wasaburo Koizumi

  2. Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan

    Guoqin Wang

  3. Department of Gastroenterology, Juntendo University School of Medicine, Nerima Hospital, Tokyo, Japan

    Shigehiro Kokubu

Authors
  1. Hisashi Hidaka
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  2. Takahide Nakazawa
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  3. Guoqin Wang
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  4. Shigehiro Kokubu
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  5. Tsutomu Minamino
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  6. Juichi Takada
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  7. Yoshiaki Tanaka
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  8. Yusuke Okuwaki
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  9. Masaaki Watanabe
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  10. Satoshi Tanabe
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  11. Akitaka Shibuya
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  12. Wasaburo Koizumi
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Corresponding author

Correspondence to Hisashi Hidaka.

Additional information

The trial described in this work has been registered under the following trial number: UMIN000003913.

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Hidaka, H., Nakazawa, T., Wang, G. et al. Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial. J Gastroenterol 47, 118–126 (2012). https://doi.org/10.1007/s00535-011-0472-0

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  • DOI: https://doi.org/10.1007/s00535-011-0472-0

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