The Effect of Rabeprazole on Injection Sclerotherapy Complications after First Attack Bleeding Esophageal Varices

ABSTRACT

Background and study aim: Endoscopic variceal sclerotherapy (EVS) effectively controls bleeding esophageal varices (OV); however it has some adverse effects including sclerosant ulcers; chest pain; dysphagia and odynophagia. Gastric acid plays a central role in mediating and aggravating these complications. Proton pump inhibitors (PPI) are the most potent pharmacologic agents for inhibition of gastric acid secretion. Therefore; these agents are the logical candidates to combat the effects that gastric acid plays in post EVS complications. However; some authors still believe that there is no strong evidence to support their use. This study was designed to evaluate the effects of the use of PPI (rabeprazole) for 8 weeks after endoscopic sclerotherapy for first attack variceal bleeding on the prevention and treatment of complications after EVS. Moreover; we aim to assess the presence of any adverse effects for the use of this drug for this period in this specific patients group.Patients and methods: One hundred patients with first attack variceal bleeding were included in the study. They were allocated randomly into a test group which received 20mg rabeprazole once daily oral dose following endoscopic sclerotherapy starting 6 hours after injection sclerotherapy and continued for 2 months and a control group which did not receive rabeprazole after sclerotherapy. For both groups; endoscopic; laboratory and clinical data were monitored every two weeks for a period 2 months. Results: The test group had significantly lower frequency of all post sclerotherapy adverse symptoms; (dysphagia; odynophagia; heart burn; retrosternal and epigastric pain as well as dyspepsia) as well as lower overall rate of re-bleeding (14 vs 46 in the control group). There were no significant differences in the hematological parameters or endoscopic findings between test and control groups. Moreover; the use of the drug for two months was not associated with any significant infectious or non infectious complications including fever; hepatic encephalopathy; SBP; diarrhea and chest infection. Conclusion: Rabeprazole use decreases post-sclerotherapy symptoms and decrease the rate of rebleeding after sclerotherapy without any increasing the complications related to acid supression