Effects Of Postoperative Use Of Proton Pump Inhibitors On Gastrointestinal Bleeding After Endoscopic Variceal Treatment During Hospitalization

Objective: 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(PPI)are widely used for various diseases related to excessive gastric acid secretion.However,the effects of PPI on the development of post-EVT complications,especially gastrointestinal bleeding(GIB),remain controversial.This study aimed to evaluate the effects of postoperative use of PPI 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 between January 2016 and June 2020 were included,all of whom were treated by an attending physician and underwent EVT during their hospitalization.Logistic regression analyses were performed to explore the effects of postoperative use of PPI on the development of post-EVT complications during hospitalization.Odds ratio(OR)with95% confidence interval(CI)was 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 PPI 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 PPI after the index EVT,use of PPI 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 PPI on the risk of post-EVT GIB or other post-EVT complications remain not statistically significant.Conclusion: Routine use of PPI after EVT should not be recommended in patients with liver cirrhosis for the prevention of post-EVT complications during hospitalization.