Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2023; 15(1): 82-93
Published online Jan 27, 2023. doi: 10.4240/wjgs.v15.i1.82
Effects of postoperative use of proton pump inhibitors on gastrointestinal bleeding after endoscopic variceal treatment during hospitalization
Yi-Yan Zhang, Le Wang, Xiao-Dong Shao, Yong-Guo Zhang, Shao-Ze Ma, Meng-Yuan Peng, Shi-Xue Xu, Yue Yin, Xiao-Zhong Guo, Xing-Shun Qi
Yi-Yan Zhang, Le Wang, Xiao-Dong Shao, Yong-Guo Zhang, Shao-Ze Ma, Meng-Yuan Peng, Shi-Xue Xu, Yue Yin, Xiao-Zhong Guo, Xing-Shun Qi, Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
Yi-Yan Zhang, Le Wang, Shi-Xue Xu, Yue Yin, Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
Shao-Ze Ma, Postgraduate College, Dalian Medical University, Dalian 116044, Liaoning Province, China
Author contributions: Qi XS contributed to conceptualization; Zhang YY, Wang L, Shao XD, Zhang YG, Ma SZ, Peng MY, Xu SX, Yin Y, Guo XZ, and Qi XS contributed to methodology; Zhang YY and Qi XS contributed to formal analysis; Zhang YY, Wang L, Shao XD, Zhang YG, Ma SZ, Peng MY, Xu SX, Yin Y, Guo XZ, and Qi XS contributed to data curation; Zhang YY and Qi XS contributed to writing original draft; Zhang YY, Wang L, Shao XD, Zhang YG, Ma SZ, Peng MY, Xu SX, Yin Y, Guo XZ, and Qi XS contributed to writing review and editing; Guo XZ and Qi XS contributed to supervision; Qi XS contributed to project administration; all authors have read and approved the final manuscript.
Institutional review board statement: This study has been approved by the Medical Ethical Committee of the General Hospital of Northern Theater Command with an approval number [Y (2022) 072] and was performed according to the Declaration of Helsinki.
Informed consent statement: The requirement for patients' informed consent for this study was waived due to its retrospective nature.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The dataset of the current study is available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xing-Shun Qi, MD, PhD, Associate Professor, Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, No. 83 Wenhua Road, Shenyang 110840, Liaoning Province, China. xingshunqi@126.com
Received: July 25, 2022
Peer-review started: July 25, 2022
First decision: September 26, 2022
Revised: October 11, 2022
Accepted: November 7, 2022
Article in press: November 7, 2022
Published online: January 27, 2023
Processing time: 176 Days and 16.7 Hours
Abstract
BACKGROUND

Endoscopic variceal treatment (EVT) is recommended as the mainstay choice for the management of high-risk gastroesophageal varices and acute variceal bleeding in liver cirrhosis. Proton pump inhibitors (PPIs) are widely used for various gastric acid-related diseases. However, the effects of PPIs on the development of post-EVT complications, especially gastrointestinal bleeding (GIB), remain controversial.

AIM

To evaluate the effects of postoperative use of PPIs on post-EVT complications in patients with liver cirrhosis during hospitalization.

METHODS

Patients with a diagnosis of liver cirrhosis who were admitted to the Department of Gastroenterology of the General Hospital of Northern Theater Command, treated by an attending physician between January 2016 and June 2020 and underwent EVT during their hospitalization were included. Logistic regression analyses were performed to explore the effects of postoperative use of PPIs on the development of post-EVT complications during hospitalization. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS

A total of 143 patients were included. The incidence of post-EVT GIB and other post-EVT complications was 4.90% and 46.85%, respectively. In the overall analyses, postoperative use of PPIs did not significantly reduce the risk of post-EVT GIB (OR = 0.525, 95%CI = 0.113-2.438, P = 0.411) or other post-EVT complications (OR = 0.804, 95%CI = 0.413-1.565, P = 0.522). In the subgroup analyses according to the enrollment period, type and route of PPIs after the index EVT, use of PPIs before the index EVT, use of vasoactive drugs after the index EVT, indication of EVT (prophylactic and therapeutic), and presence of portal venous system thrombosis, ascites, and hepatocellular carcinoma, the effects of postoperative use of PPIs on the risk of post-EVT GIB or other post-EVT complications remain not statistically significant.

CONCLUSION

Routine use of PPIs after EVT should not be recommended in patients with liver cirrhosis for the prevention of post-EVT complications during hospitalization.

Keywords: Endoscopic variceal treatment; Gastrointestinal bleeding; Proton pump inhibitors; Complications; Liver cirrhosis; Acute variceal bleeding

Core Tip: The role of proton pump inhibitors (PPIs) in the management of post-endoscopic variceal treatment (EVT) complications remains controversial. We conducted a retrospective study to explore the effects of postoperative use of PPIs on post-EVT gastrointestinal bleeding (GIB) and other post-EVT complications in patients with liver cirrhosis during hospitalization. We found that postoperative use of PPIs was not beneficial for reducing the development of post-EVT GIB and other post-EVT complications during hospitalization. Collectively, routine use of PPIs after EVT during hospitalization may not be recommended, and their indications should be carefully evaluated.