S3178 Do Proton Pump Inhibitors Prevent Rebleeding From Varices? A Retrospective Study

Abstract

INTRODUCTION: The risk of re-bleeding after initial hemostasis of a variceal hemorrhage is high and is associated with a high mortality rate. Adjunct proton pump inhibitor (PPI) use is advocated by some studies for 10-14 days after endoscopic variceal ligation (EVL) to prevent re-bleeding through decreased post-EVL ulcer size but many patients continue to take PPI for a longer duration. Additionally, PPIs are known to cause more adverse effects in cirrhotic patients than patients without chronic liver disease. Our objective was to study how many patients who presented with acute variceal bleeding (AVB) were started on a PPI long-term and if it had any impact on re-bleeding. METHODS: We conducted a retrospective chart review of patients admitted between 2012 to 2020 with AVB and were over age 18. We collected data about patient characteristics, re-bleeding rates and duration of PPI intake. We excluded patients who did not receive standard therapy or achieve adequate hemostasis at the time of initial bleeding, Child’s class C, hepatocellular carcinoma and portal vein thrombosis. Statistical analysis was conducted in SPSS version 25 to compute means and frequencies of patient characteristics. Chi–Square tests were done to test differences between patients who re-bled and those who did not. RESULTS: A total of 249 patients were included in the study out of 345 who had AVB. A majority of patients were males (67.1%) and Caucasians (75.1%). The median age was 60 years. Alcoholic cirrhosis was the most common etiology in our patients. Table 1 includes a list of our patient characteristics. No significant differences were seen in re-bleeding rates with or without PPI use up to 2 week after variceal bleeding (P = 0.34). Patients who were treated with PPI > 2 weeks had higher re-bleeding rates, a difference that approached significance (P = 0.05) (Table 2). CONCLUSION: Our data shows that a majority of patients were on PPI beyond 2 weeks after AVB and the risk of variceal re-bleeding increases in patients treated with PPI therapy > 2 weeks. It is currently recommended that PPI be stopped 10-14 days after EVL unless there is another compelling indication for long-term therapy. Prospective studies should be performed to confirm our results.Table 1.: Demographics, liver disease status and rebleeding data of study patientsTable 2.: Rebleeding rates and association with PPI usage