We read with great interest the recent article by Yadav et al on the use of proton pump inhibitors (PPI) after endoscopic variceal ligation (EVL).1 In this single-blind randomised controlled trial (RCT), the authors demonstrated a significant reduction in rebleeding risk and mortality in patients taking PPI after EVL. While this is undoubtedly an important trial, several concerns about its design and implementation merit careful consideration.
First, the rebleeding rate in the non-PPI group at 3 months was nearly 30%, which is disproportionately high and exceeds the rebleeding rates observed in the previously published RCTs on risk of rebleeding after EVL, despite those studies having much longer follow-up.2–5 In addition, this rate of rebleeding (even if presumed to be due to post-EVL ulcers) is substantially higher than that reported in the literature.6 7 Interpretation of these results…
