Proton Pump Inhibitor Use Following Esophageal Variceal Ligation and Its Impact on Clinical Outcomes: Real-World Data...

Area of Science:

• Gastroenterology
• Hepatology
• Clinical Pharmacology

Background:

• Proton pump inhibitors (PPIs) are commonly prescribed post-endoscopic variceal ligation (EVL) to prevent bleeding.
• Evidence on PPI efficacy and safety in this context is mixed, with potential risks in cirrhotic patients.

Purpose of the Study:

• To evaluate the outcomes of PPI use following elective EVL for primary prophylaxis in patients with cirrhosis and esophageal varices.
• To assess the impact of PPIs on bleeding events and adverse events.

Main Methods:

• Retrospective cohort study using the TriNetX global health research network.
• Compared patients receiving PPIs for at least two weeks post-EVL versus those not receiving PPIs within one month.
• Propensity score matching was used to balance cohorts for analysis of outcomes at 4 and 8 weeks.

Main Results:

• PPI use was not associated with reduced esophageal bleeding at 4 or 8 weeks.
• A significantly higher composite adverse event rate was observed in the PPI group at 4 and 8 weeks.
• PPI use was linked to increased hepatic encephalopathy and acute kidney injury (AKI), with higher mortality at 8 weeks.

Conclusions:

• Routine PPI use after prophylactic EVL in cirrhotic patients does not reduce bleeding risk.
• PPIs are associated with a significant increase in adverse events, including AKI and hepatic encephalopathy.
• The routine use of PPIs following EVL for primary prophylaxis warrants reconsideration.