A randomized controlled trial to study the effect of PPI vs No-PPI after EVL on recurrent bleeding episodes in patients of liver cirrhosis with acute variceal bleeding

Proton Pump Inhibitors (PPI) are extensively used in many acid related disorders due to their high efficacy in inhibiting gastric acid secretion. They are also often used in cirrhosis patients with variceal or portal hypertensive gastropathic bleeding to prevent peptic complications. The prevalence of varices is around 30% in compensated and 60% in decompensated cirrhotic patients. Apart from Child-Pugh score, the size of varices is also a risk factor for variceal bleeding where medium and large esophageal varices bleed at higher rate than small esophageal varices. Endoscopic variceal band ligation (EVL) is currently recommended therapy of choice in patients with acute variceal bleeding along with vasoconstrictors. Non selective beta blockers are also used along with EVL for primary as well as secondary prophylaxis of esophageal varices. There is a constant search going on for effective non-invasive therapies in patients with variceal bleed and PPIs owing to their safety profile and efficacy in non variceal bleed are being considered a candidate for the same. The latest Baveno VII guidelines also advise to stop PPIs after endoscopic therapy unless there is clear indication to continue them, but the level of evidence for the statement is very low and strength of recommendation is weak.

In this study we would aim to determine the effect of PPI on recurrent episodes of variceal bleeding after EVL in liver cirrhosis patients that would help making informed decision regarding the use of PPIs in cases with variceal bleeding.