Korean J Gastroenterol.  2008 Apr;51(4):232-240.

The Effect of Proton Pump Inhibitor on Healing of Post-esophageal Variceal Ligation Ulcers

• Boo GB
• Oh JC
• Lee BJ
• Lee DM
• Kim YD
• Park CG
• Kim MW

Abstract

BACKGROUNE/AIMS: Esophageal variceal ligation (EVL) is the most preferable method for controling variceal bleeding. However, EVL is associated with complications such as hemorrhage, chest pain, dysphagia, and odynophagia due to post-EVL ulcers in the esophageal mucosa. The aim of this study was to assess the effect of proton pump inhibitor (PPI), pantoprazole on the healing of post-EVL ulcers. METHODS: Forty seven patients were randomly allocated into PPI group and control group. Patients in PPI group received 40 mg of pantoprazole intravenously for 3 days after EVL, then 40 mg of oral pantoprazole for 11 days consecutively. Control patients received intravenous and oral placebo. Endoscopic examinations were performed twice at 7+/-2 days and 14+/-2 days after EVL respectively. Clinical outcomes include the size of ulcers, symptoms reported by patients; chest pain, dysphagia, and odynophagia. RESULTS: Forty seven patients completed the 7 days protocol (PPI/control; 25/22), and twenty six patients completed the 14 days protocol (PPI/control; 16/10). Post-EVL ulcers in PPI group were significantly smaller than those in control group (7 days; 98.7 mm2/119.4 mm2, 14 days; 32.3 mm2/43.8 mm2, p<0.01). No difference was observed between two the groups with respect to summations of symptom scores (p>0.05). Nineteen patients (PPI/control; 9/10) did not complete the 14 days protocol due to patients' refusal and adverse outcomes, such as hepatic failure and sepsis with bleeding from post-EVL ulcer occurred in two patients of control group. CONCLUSIONS: PPI treatment following EVL may be effective in healing post-EVL ulcer.

Keyword

Esophageal variceal ligation; Ulcer; Proton pump inhibitor; Symptom score

MeSH Terms

2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage/*therapeutic use
Anti-Ulcer Agents/administration & dosage/*therapeutic use
Esophageal and Gastric Varices/complications/*surgery
Esophagoscopy
Female
Gastrointestinal Hemorrhage/prevention & control
Humans
Ligation
Male
Middle Aged
Proton Pump Inhibitors/administration & dosage/*therapeutic use
Regression Analysis
Sickness Impact Profile
Ulcer/*drug therapy/etiology