Can proton pump inhibitors reduce rebleeding following Histoacryl sclerotherapy for gastric variceal hemorrhage?
OBJECTIVE
To evaluate the efficacy of proton pump inhibitors (PPIs) in reducing rebleeding and bleeding-related death rates after endoscopic gastric variceal obliteration (GVO) using N-butyl-2-cyanoacrylate (NBC).


METHODS
This study enrolled 341 patients who were consecutively diagnosed with and treated for bleeding gastric varices. The patients were divided into PPI and non-PPI groups, and their endoscopic findings, initial hemostasis outcomes, rebleeding and bleeding-related death rates, and treatment-related complications were analyzed.


RESULTS
The rate of initial hemostasis was 97.1%. rebleeding occurred in 2.2% of patients within 2 weeks, 3.9% of patients within 4 weeks, 18.9% of patients within 6 months, and 27.6% of patients within 12 months of the GVO procedure. A previous history of variceal bleeding (relative risk [RR], 1.955; 95% confidence interval [CI], 1.263 to 3.028; p = 0.003) and use of PPIs (RR, 0.554; 95% CI, 0.352 to 0.873; p = 0.011) were associated with rebleeding. Child-Pugh class C (RR, 10.914; 95% CI, 4.032 to 29.541; p < 0.001), failure of initial hemostasis (RR, 13.329; 95% CI, 2.795 to 63.556; p = 0.001), and the presence of red-colored concomitant esophageal varices (RR, 4.096; 95% CI, 1.320 to 12.713; p = 0.015) were associated with bleeding-related death.


CONCLUSIONS
The prophylactic use of PPIs reduces rebleeding after GVO using NBC in patients with gastric variceal hemorrhage. However, prophylactic use of PPIs does not reduce bleeding-related death.
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Ka Rham
KR
Kim
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Chung Hwan
CH
Jun
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Kyu Man
KM
Cho
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Jin Woo
JW
Wi
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Seon Young
SY
Park
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Sung Bum
SB
Cho
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Wan Sik
WS
Lee
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Chang Hwan
CH
Park
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Young Eun
YE
Joo
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Hyun Soo
HS
Kim
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Sung Kyu
SK
Choi
Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Jong Sun
JS
Rew
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004659:Enbucrilate / Q000008:administration & dosage* / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D054328:Proton Pump Inhibitors; D012597:Sclerosing Solutions; D004659:Enbucrilate
Cyanoacrylates; Endoscopic; Esophageal and gastric varices; Hemostasis; Proton pump inhibitors; Treatment outcome