title: Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University East Hospital, 2-1-1 Asamizodai, Minami-ku, Sagamihara, Kanagawa 252-0380, Japan. hisashi7@kitasato-u.ac.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hidaka
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Guoqin
authors.initials: G
authors.lastname: Wang
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Kokubu
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Minamino
authors.forename: Juichi
authors.initials: J
authors.lastname: Takada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuwaki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanabe
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000368:Aged; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole; D017211:Treatment Failure
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064750:Rabeprazole