Proton pump inhibitors should be continued after endoscopic variceal ligation

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.