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.