Boo Gwi Beom, Oh Jong Chan, Lee Beom Ju, Lee Dong Min, Kim Young Dae, Park Chan Guk, Kim Man Woo
Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea.
Korean J Gastroenterol. 2008 Apr;51(4):232-40.
BACKGROUND/AIMS: Esophageal variceal ligation (EVL) is the most preferable method for controlling variceal bleeding. However, EVL is associated with complications such as hemorrhage, chest pain, dysphagia, and odynophagia due to post-EVL ulcers in the esophageal mucosa. The aim of this study was to assess the effect of proton pump inhibitor (PPI), pantoprazole on the healing of post-EVL ulcers.
Forty seven patients were randomly allocated into PPI group and control group. Patients in PPI group received 40 mg of pantoprazole intravenously for 3 days after EVL, then 40 mg of oral pantoprazole for 11 days consecutively. Control patients received intravenous and oral placebo. Endoscopic examinations were performed twice at 7+/-2 days and 14+/-2 days after EVL respectively. Clinical outcomes include the size of ulcers, symptoms reported by patients; chest pain, dysphagia, and odynophagia.
Forty seven patients completed the 7 days protocol (PPI/control; 25/22), and twenty six patients completed the 14 days protocol (PPI/control; 16/10). Post-EVL ulcers in PPI group were significantly smaller than those in control group (7 days; 98.7 mm2/119.4 m2, 14 days; 32.3 m2/43.8 m2, p<0.01). No difference was observed between two the groups with respect to summations of symptom scores (p> 0.05). Nineteen patients (PPI/control; 9/10) did not complete the 14 days protocol due to patients' refusal and adverse outcomes, such as hepatic failure and sepsis with bleeding from post-EVL ulcer occurred in two patients of control group.
PPI treatment following EVL may be effective in healing post-EVL ulcer.
背景/目的：食管静脉曲张结扎术（EVL）是控制静脉曲张出血的最优选方法。然而，EVL与诸如出血、胸痛、吞咽困难以及因食管黏膜EVL术后溃疡导致的吞咽痛等并发症相关。本研究的目的是评估质子泵抑制剂（PPI）泮托拉唑对EVL术后溃疡愈合的影响。
47例患者被随机分为PPI组和对照组。PPI组患者在EVL术后静脉注射40mg泮托拉唑，持续3天，然后连续11天口服40mg泮托拉唑。对照患者接受静脉和口服安慰剂。分别在EVL术后7±2天和14±2天进行两次内镜检查。临床结果包括溃疡大小、患者报告的症状；胸痛、吞咽困难和吞咽痛。
47例患者完成了7天方案（PPI/对照组；25/22），26例患者完成了14天方案（PPI/对照组；16/10）。PPI组的EVL术后溃疡明显小于对照组（7天；98.7mm²/119.4m²，14天；32.3m²/43.8m²，p<0.01）。两组在症状评分总和方面未观察到差异（p>0.05）。19例患者（PPI/对照组；9/10）由于患者拒绝和不良结局未完成14天方案，对照组有2例患者发生了诸如肝衰竭和EVL术后溃疡出血导致的败血症等不良结局。
EVL术后进行PPI治疗可能对EVL术后溃疡的愈合有效。
