title: Effect of proton pomp inhibitor (PPI : Rabeprazole) on reflux esophagitis after endoscopic injection sclerotherapy (EIS), a randomized control study (24 hour-pH monitoring).
abstract: BACKGROUND
  Transient esophageal ulceration is a common finding after sclerotherapy of varices. These ulcers sometimes cause pain, ulcer bleeding, and stricture formation. Gastroesophageal reflux (GER) after Endoscopic injection sclerotherapy (EIS) is a known cause of worsening ulcer formation. Therefore, an efficient drug for GER is desirable to improve the quality of life of patients with esophageal varices.
  
  
  METHODS
  We randomized 18 Japanese cirrhotic patients who had risky esophageal varices. The patients were randomly allocated into two groups, and during EIS sessions, one group was administered proton pump inhibitor(PPI) (Rabeprazole 20 mg a person once a day), while the other received histamine H2 receptor antagonist (H2-blocker) (famotidine 20 mg a person, twice a day). Gastroesophageal reflux was monitored by a 24-h pH-monitoring catheter introduced into the distal esophagus. Ulcer formation was evaluated using an endoscopic examination. The subjective and objective symptoms were also compared between the two groups.
  
  
  RESULTS
  All patients in the H2-blocker group showed an increased percentage of time with pH < 4.0 after EIS sessions, but no patients in the PPI group showed an increased such symptoms. The H2-blocker group also experienced a significantly higher number of days of heartburn and dysphasia than did the PPI group (p = 0.017, p = 0.042). The rate of ulcer improvement was found to be faster in Rabeprazole group than in H2 blocker group (p = 0.008).
  
  
  CONCLUSIONS
  These results suggest that Rabeprazole treatment prevents EIS-associated gastroesophageal reflux and promotes ulcer healing. Rabeprazole also improve the subjective symptoms following EIS.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D015738:Famotidine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D064750:Rabeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D015738:Famotidine