Impact of Ulcer Healing Medications on Outcome after Esophageal Variceal Ligation in Patients with Liver Cirrhosis

Endoscopic variceal band ligation (EVL) has been used successfully for the prophylaxis and therapy of variceal bleeding. Empirical treatment of post-band ulcers with medications used for treatment of peptic ulcers with or without prophylactic antibiotics is sometimes used with conflicting data regarding their beneficial effect ulcers’ healing. Aim of the work is to study the impact of use of ulcer healing medications on healing and early UGIB from post EVL ulcers. 250 patients with liver cirrhosis and esophageal varices underwent EVL. Patients were randomly subdivided into five equal subgroups. Four types of regimens containing ulcer healing medications and antibiotics were used: Group 1: included patients treated by Pantoprazole 40 mg/day for 14 days, Group 2: included patients treated by Pantoprazole 40 mg/day for 14 days plus Rebamipide 100 mg three times daily for 14 days, Group 3: included patients treated by Pantoprazole 40 mg/day for 14 days plus Ciprofloxacin 750 mg/day for 7days, Group 4: included patients treated by Pantoprazole 40 mg/ day for 14 days plus Ciprofloxacin 750 mg/ day for 7days and Rebamipide 100 mg three times daily for 14 days and Group 5: included patients who did not receive any ulcer healing medications after EVL. Patients were re- evaluated by EGD after 4 weeks to assess healing of post band ulcers. Early UGIB (hematemesis, and/or melena) occurring within 4 weeks after EVL was recorded. 184 patients showed healing of post EVL ulcers while 66 patients had bad healing signs. Also, 196 patients developed UGIB after EVL while 54 patients passed the follow up period with no UGIB. None of the ulcer healing medications’ regimens had significant impact on healing of post EVL ulcers nor development of UGIB. The use of ulcer healing medications to aid healing of post EVL ulcers is still questionable.