The Effect of Proton Pomp Inhibitor (PPI : Rabeprazole) on Reflux Esophagitis after Endoscopic Injection Sclerotherapy (EIS), a Randomized Control Study (24 hour-pH monitoring)

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  • Akahoshi Tomohiko
    Department of Disaster and Emergency of Medicine, Kyushu University | Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Kawanaka Hirofumi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Tomikawa Morimasa
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Saeki Hiroshi
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Uchiyama Hideaki
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Ikeda Tetsuo
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Shirabe Ken
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Hashizume Makoto
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Maehara Yoshihiko
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

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Other Title
  • 内視鏡的硬化療法後の胃酸逆流に対するプロトンポンプ阻害剤ラベプラゾールの治療効果の検討 : (24時間PHモニターを用いた無作為化比較研究)

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Background : Transient esophageal ulceration is a common finding after sclerotherapy of varices. These ulcers sometimes cause pain, ulcer bleeding, and stricture formation. Gastroesophageal reflux (GER) after Endoscopic injection sclerotherapy (EIS) is a known cause of worsening ulcer formation. Therefore, an efficient drug for GER is desirable to improve the quality of life of patients with esophageal varices. Methods : We randomized 18 Japanese cirrhotic patients who had risky esophageal varices. The patients were randomly allocated into two groups, and during EIS sessions, one group was administered proton pump inhibitor (PPI) (Rabeprazole 20mg a person once a day), while the other received histamine H2 receptor antagonist (H_2-blocker) (famotidine 20mg a person, twice a day). Gastroesophageal reflux was monitored by a 24-h pH-monitoring catheter introduced into the distal esophagus. Ulcer formation was evaluated using an endoscopic examination. The subjective and objective symptoms were also compared between the two groups. Results : All patients in the H_2-blocker group showed an increased percentage of time with pH < 4.0 after EIS sessions, but no patients in the PPI group showed an increased such symptoms. The H2-blocker group also experienced a significantly higher number of days of heartburn and dysphasia than did the PPI group (p = 0.017, p = 0.042). The rate of ulcer improvement was found to be faster in Rabeprazole group than in H_2 blocker group (p = 0.008). Conclusion : These results suggest that Rabeprazole treatment prevents EIS-associated gastroesophageal reflux and promotes ulcer healing. Rabeprazole also improve the subjective symptoms following EIS.

Journal

  • 福岡醫學雜誌

    福岡醫學雜誌 104 (12), 483-489, 2013-12-25

    Fukuoka Medical Association

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