Conclusions in search of a confirmatory analysis: the evidence does not yet justify routine proton pump inhibitors after endoscopic variceal ligation

The trial by Yadav and colleagues concludes that proton pump inhibitors (PPIs) should be continued routinely after endoscopic variceal ligation (EVL).1 The data show a plausible directional signal of benefit, and the authors candidly acknowledge several limitations of their own analysis. We outline why this signal does not yet justify a change to current guideline-oriented practice.