Can proton pump inhibitors reduce rebleeding following Histoacryl sclerotherapy for gastric variceal hemorrhage?.
10.3904/kjim.2015.30.5.593
- Author:
Ka Rham KIM
1
;
Chung Hwan JUN
;
Kyu Man CHO
;
Jin Woo WI
;
Seon Young PARK
;
Sung Bum CHO
;
Wan Sik LEE
;
Chang Hwan PARK
;
Young Eun JOO
;
Hyun Soo KIM
;
Sung Kyu CHOI
;
Jong Sun REW
Author Information
1. Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. estevanj@naver.com
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Cyanoacrylates;
Esophageal and gastric varices;
Hemostasis;
Endoscopic;
Proton pump inhibitors;
Treatment outcome
- MeSH:
Adult;
Aged;
Aged, 80 and over;
Chi-Square Distribution;
Enbucrilate/*administration & dosage/adverse effects;
Endoscopy, Gastrointestinal;
Esophageal and Gastric Varices/complications/diagnosis/mortality/*therapy;
Female;
Gastrointestinal Hemorrhage/diagnosis/etiology/mortality/*therapy;
Hemostasis, Endoscopic/adverse effects/*methods/mortality;
Humans;
Logistic Models;
Male;
Middle Aged;
Multivariate Analysis;
Odds Ratio;
Proton Pump Inhibitors/adverse effects/*therapeutic use;
Recurrence;
Retrospective Studies;
Risk Factors;
Sclerosing Solutions/*administration & dosage/adverse effects;
Sclerotherapy/adverse effects/*methods/mortality;
Time Factors;
Treatment Outcome;
Young Adult
- From:The Korean Journal of Internal Medicine
2015;30(5):593-601
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: 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.
