Current guidelines do not recommend routine proton pump inhibitor (PPI) use after endoscopic variceal ligation (EVL) because of limited evidence. In this randomised controlled trial of 170 patients (66.5% with alcohol-related liver disease), PPI therapy (40 mg daily for 3 months) was compared with no PPI treatment. Recurrent bleeding at 2 weeks and 3 months was significantly more frequent in the no-PPI group in both intention-to-treat (ITT) and per-protocol (PP) analyses, with absolute differences of 10%–15%. All deaths in the no-PPI group were related to rebleeding. Post-EVL ulcer extent and pain were also significantly reduced with PPI therapy. These findings indicate that post-EVL PPI use reduces rebleeding risk and may also lower associated mortality.
The most recent Baveno VII guidelines recommend discontinuing PPIs after EVL unless there is a clear ongoing indication, although this recommendation is based on low-quality evidence and carries a weak strength of recommendation.
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