Acid suppression in patients treated with endoscopic therapy for the management of gastroesophageal varices: a systematic review and meta-analysis

ABSTRACT

Background and aim: Endoscopic therapy is the cornerstone choice for the management of varices and variceal hemorrhage. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of acid suppression in patients treated with endoscopic therapy for gastroesophageal varices.

Methods: All eligible studies were searched via the PubMed, EMBASE, and Cochrane Library databases. Incidence of bleeding, mortality, ulcers, chest pain, and dysphagia after endoscopic therapy and length of stay were analyzed. Subgroup analyses were performed according to the types and major indications of endoscopic treatments. Odds ratios (ORs) with 95% confidence intervals (95%CIs) were calculated.

Results: Nine studies with 1470 patients were included. Acid suppression could significantly decrease the incidence of bleeding (OR = 0.39, 95%CI: 0.19–0.81, P = 0.01) and diminish the ulcer size (OR = 0.78, 95%CI: 0.38–1.57, P = 0.48) after endoscopic therapy. The subgroup analyses showed that acid suppression could significantly decrease the incidence of bleeding in patients undergoing prophylactic EVL, rather than in patients undergoing therapeutic EVL. There was no significant difference in the incidence of mortality, ulcers, chest pain, and dysphagia and length of stay between patients treated with and without acid suppression.

Conclusion: Acid suppression might be considered in patients undergoing prophylactic EVL for gastroesophageal varices.

KEYWORDS:

• Acid suppression
• adverse events
• endoscopic therapy
• varices
• meta-analysis

Author contributions

Jia Zhu: designed the studies, performed the literature search and selection, data extraction, and quality assessment, and drafted the manuscript.

Xingshun Qi: designed the studies, performed the literature search and selection, gave critical comments, and revised the manuscript.

Haonan Yu and Chunping Su: performed the literature selection, data extraction, and quality assessment.

Xiaozhong Guo: gave critical comments and revised the manuscript.

All authors have made an intellectual contribution to the manuscript and approved the submission.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This study was partially supported by the grants from the National Natural Science Foundation of China (no. 81500474), Natural Science Foundation of Liaoning Province (no. 2015020409), and China Postdoctoral Science Foundation (2015M582886) for Dr. Xingshun Qi.