The Efficacy of Proton Pump Inhibitor in Cirrhotics with Variceal Bleeding: A Systemic Review and Meta-Analysis

• Published in: Digestion Vol. 102; no. 2; pp. 117 - 127
• Main Authors: Lin, Lin, Cui, Binxin, Deng, You, Jiang, Xihui, Liu, Wentian, Sun, Chao
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland 2021
• Subjects: To the Point Article; Re-bleeding rate; Mortality; Proton pump inhibitor; Gastroesophageal variceal bleeding
• ISSN: 0012-2823; 1421-9867
• DOI: 10.1159/000505059

Background and Aims: Proton pump inhibitor (PPI) was widely used in cirrhotic patients with variceal bleeding empirically rather than evidence-based practice. We aimed to evaluate the plausible indication of PPI use in variceal bleeding cirrhotic patients and figure out whether it can decrease the re-bleeding rate after endoscopic therapy. Furthermore, we also investigated the association between PPI and bleeding-related mortality in these patients. Methods: We have searched in PubMed, Medline, Web of Science, Google Scholar, Cochrane and Embase prior to May 2019. Pooled OR and 95% CI were calculated by random-effects model. Results: A total of 11 original articles including 1,818 cirrhotic patients were analyzed. The overall meta-analysis highlighted that PPI use may decrease the re-bleeding rate after endoscopic therapy (OR 0.52, 95% CI 0.35–0.77). The conclusion was irrespective of study methods, endoscopic purpose and hemorrhage sites. However, the conclusion speculated that PPI should be prescribed >1 month. Meanwhile, PPI use may not impact the bleeding-related mortality. Conclusions: PPI, used for >1 month, can decrease re-bleeding rate after endoscopic therapy in cirrhotic patients for prophylaxis or emergency treatment purpose. No matter how long it takes, PPI use is not associated with bleeding-related mortality.