Effects of postoperative use of proton pump inhibitors on gastrointestinal bleeding after endoscopic variceal treatment during hospitalization

Yi-Yan Zhang; Le Wang; Xiao-Dong Shao; Yong-Guo Zhang; Shao-Ze Ma; Meng-Yuan Peng; Shi-Xue Xu; Yue Yin; Xiao-Zhong Guo; Xing-Shun Qi

doi:10.4240/wjgs.v15.i1.82

Effects of postoperative use of proton pump inhibitors on gastrointestinal bleeding after endoscopic variceal treatment during hospitalization

World J Gastrointest Surg. 2023 Jan 27;15(1):82-93. doi: 10.4240/wjgs.v15.i1.82.

Authors

Yi-Yan Zhang^{1

2}, Le Wang^{1

2}, Xiao-Dong Shao¹, Yong-Guo Zhang¹, Shao-Ze Ma^{1

3}, Meng-Yuan Peng¹, Shi-Xue Xu^{1

2}, Yue Yin^{1

2}, Xiao-Zhong Guo¹, Xing-Shun Qi⁴

Affiliations

¹ Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China.
² Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China.
³ Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China.
⁴ Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China. xingshunqi@126.com.

Abstract

Background: Endoscopic variceal treatment (EVT) is recommended as the mainstay choice for the management of high-risk gastroesophageal varices and acute variceal bleeding in liver cirrhosis. Proton pump inhibitors (PPIs) are widely used for various gastric acid-related diseases. However, the effects of PPIs on the development of post-EVT complications, especially gastrointestinal bleeding (GIB), remain controversial.

Aim: To evaluate the effects of postoperative use of PPIs on post-EVT complications in patients with liver cirrhosis during hospitalization.

Methods: Patients with a diagnosis of liver cirrhosis who were admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command, treated by an attending physician between January 2016 and June 2020 and underwent EVT during their hospitalization were included. Logistic regression analyses were performed to explore the effects of postoperative use of PPIs on the development of post-EVT complications during hospitalization. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: A total of 143 patients were included. The incidence of post-EVT GIB and other post-EVT complications was 4.90% and 46.85%, respectively. In the overall analyses, postoperative use of PPIs did not significantly reduce the risk of post-EVT GIB (OR = 0.525, 95%CI = 0.113-2.438, P = 0.411) or other post-EVT complications (OR = 0.804, 95%CI = 0.413-1.565, P = 0.522). In the subgroup analyses according to the enrollment period, type and route of PPIs after the index EVT, use of PPIs before the index EVT, use of vasoactive drugs after the index EVT, indication of EVT (prophylactic and therapeutic), and presence of portal venous system thrombosis, ascites, and hepatocellular carcinoma, the effects of postoperative use of PPIs on the risk of post-EVT GIB or other post-EVT complications remain not statistically significant.

Conclusion: Routine use of PPIs after EVT should not be recommended in patients with liver cirrhosis for the prevention of post-EVT complications during hospitalization.

Keywords: Acute variceal bleeding; Complications; Endoscopic variceal treatment; Gastrointestinal bleeding; Liver cirrhosis; Proton pump inhibitors.