Comparison of Rabeprazole and Vonoprazan in the Prevention of Post-endoscopic Variceal Ligation Ulcer in Patients With Cirrhosis

NCT07608536 | Not Yet Recruiting Phase 3 DMC

• 1 other identifier: 2355/Ethics/2026
• Study Type: interventional
• Target: 300
• Locations: 1 country
• Sites: 1

Brief Summary

The study aims to to evaluate Vonoprazan effectiveness in prevention of post endoscopic variceal ligation (EVL) ulcer and its related bleed in comparison to Rabeprazole. All patients who are eligible for the study will be screened from outpatient department and endoscopy lab. Patients who are diagnosed to have oesophageal varices and requiring EVL will be enrolled after fulfilling inclusion and exclusion criteria. Patient clinical and demographic data will be collected in proforma. Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. One arm is Vonoprazan 20 mg once a day group and second arm will be rabeprazole 20 mg once a day. Duration of therapy will be 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care. Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

Conditions

Endoscopic Variceal Band Ligation

Keywords

Post endoscopic variceal ligation (EVL) ulcer; Vonoprazan; Rabeprazole

Outcome Measures

Primary Outcomes (2)

• To compare the maximum post-EVL esophageal ulcer diameter (mm) at 2 weeks (Day 14), measured on surveillance upper GI endoscopy, between the Vonoprazan and Rabeprazole groups.

  Two weeks

• To compare the number of post-EVL ulcers per participant at Day 14, and the severity of any bleeding ulcers (graded by the Jamwal & Sarin classification), between the Vonoprazan and Rabeprazole groups

  Two weeks

Secondary Outcomes (1)

• To compare the incidence of adverse effects in Vonoprazan and Rabeprazole groups

  Two weeks

Study Arms (2)

Role of Vonoprazan in prevention of post EVL ulcer

EXPERIMENTAL

Patients who are diagnosed to have esophageal varices and requiring EVL will be enrolled Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. The experimental arm will receive Vonoprazan 20 mg once a day for 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care. Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

Drug: Vonoprazan

Role of Rabeprazole in prevention of post EVL ulcer

ACTIVE COMPARATOR

Patients who are diagnosed to have esophageal varices and requiring EVL will be enrolled Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. The comparator arm will receive Rabeprazole 20 mg once a day for 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care. Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

Drug: Rabeprazol

Interventions

Vonoprazan DRUG

Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. One arm is Vonoprazan 20 mg once a day group and second arm will be rabeprazole 20 mg once a day. Duration of therapy will be 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care. Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

Role of Vonoprazan in prevention of post EVL ulcer

Rabeprazol DRUG

Patients who are willing to participate in the study will be randomized into two arms in 1:1 ratio. One arm is Vonoprazan 20 mg once a day group and second arm will be rabeprazole 20 mg once a day. Duration of therapy will be 2 weeks. Patients will also be advised to take nonselective beta blockers (NSBB) as per standard of care. Patients will undergo upper GI endoscopy after 2 weeks to evaluate varices and ulcers, ulcer will be classified according to Jamwal \& Sarin classification system.

Role of Rabeprazole in prevention of post EVL ulcer

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years and above
• Diagnosis of portal hypertension and esophageal varix should be established by endoscopy.
• Who are willing to participate in the study

You may not qualify if:

• Negative consent
• Diagnosed with HCC
• Already taking PPI/Vonoprazan for other indications
• Using anticoagulants and antiplatelets

Sponsors & Collaborators

• King George's Medical University: lead

Study Sites (1)

King George Medical University

Lucknow, Uttar Pradesh, 226003, India

Location

Related Publications (12)

• Jamwal KD, Maiwall R, Sharma MK, Kumar G, Sarin SK. Case Control Study of Post-endoscopic Variceal Ligation Bleeding Ulcers in Severe Liver Disease: Outcomes and Management. J Clin Transl Hepatol. 2019 Mar 28;7(1):32-39. doi: 10.14218/JCTH.2018.00059. Epub 2019 Mar 10.

  PMID: 30944817 RESULT

• Lashen SA, Shamseya MM, Shamseya AM, Hablass FH. Efficacy of Vonoprazan vs. Pantoprazole or Non-acid Suppression in Prevention of Post-variceal Ligation Ulcer Bleeding in Portal Hypertension: A Multi-arm Randomized Controlled Trial. J Clin Exp Hepatol. 2023 Nov-Dec;13(6):962-971. doi: 10.1016/j.jceh.2023.05.008. Epub 2023 May 19.

  PMID: 37975046 RESULT

• Oshima T, Miwa H. Potent Potassium-competitive Acid Blockers: A New Era for the Treatment of Acid-related Diseases. J Neurogastroenterol Motil. 2018 Jul 30;24(3):334-344. doi: 10.5056/jnm18029.

  PMID: 29739175 RESULT

• Lo EA, Wilby KJ, Ensom MH. Use of proton pump inhibitors in the management of gastroesophageal varices: a systematic review. Ann Pharmacother. 2015 Feb;49(2):207-19. doi: 10.1177/1060028014559244.

  PMID: 25583938 RESULT

• Garcia-Saenz-de-Sicilia M, Sanchez-Avila F, Chavez-Tapia NC, Lopez-Arce G, Garcia-Osogobio S, Ruiz-Cordero R, Tellez-Avila FI. PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis. World J Gastroenterol. 2010 Dec 14;16(46):5869-73. doi: 10.3748/wjg.v16.i46.5869.

  PMID: 21155009 RESULT

• Cho E, Jun CH, Cho SB, Park CH, Kim HS, Choi SK, Rew JS. Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies? Medicine (Baltimore). 2017 Jun;96(24):e7157. doi: 10.1097/MD.0000000000007157.

  PMID: 28614248 RESULT

• Hidaka H, Nakazawa T, Wang G, Kokubu S, Minamino T, Takada J, Tanaka Y, Okuwaki Y, Watanabe M, Tanabe S, Shibuya A, Koizumi W. Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation: a randomized, controlled trial. J Gastroenterol. 2012 Feb;47(2):118-26. doi: 10.1007/s00535-011-0472-0. Epub 2011 Sep 28.

  PMID: 21947706 RESULT

• Polski JM, Brunt EM, Saeed ZA. Chronology of histological changes after band ligation of esophageal varices in humans. Endoscopy. 2001 May;33(5):443-7. doi: 10.1055/s-2001-14259.

  PMID: 11396765 RESULT

• Lin L, Cui B, Deng Y, Jiang X, Liu W, Sun C. The Efficacy of Proton Pump Inhibitor in Cirrhotics with Variceal Bleeding: A Systemic Review and Meta-Analysis. Digestion. 2021;102(2):117-127. doi: 10.1159/000505059. Epub 2020 Feb 21.

  PMID: 32088712 RESULT

• Sinclair M, Vaughan R, Angus PW, Gow PJ, Parker F, Hey P, Efthymiou M. Risk factors for band-induced ulcer bleeding after prophylactic and therapeutic endoscopic variceal band ligation. Eur J Gastroenterol Hepatol. 2015 Aug;27(8):928-32. doi: 10.1097/MEG.0000000000000387.

  PMID: 25951490 RESULT

• Petrasch F, Grothaus J, Mossner J, Schiefke I, Hoffmeister A. Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis. BMC Gastroenterol. 2010 Jan 15;10:5. doi: 10.1186/1471-230X-10-5.

  PMID: 20074379 RESULT

• de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974. doi: 10.1016/j.jhep.2021.12.022. Epub 2021 Dec 30.

  PMID: 35120736 RESULT

Related Links

• https://pubmed.ncbi.nlm.nih.gov/35120736/

MeSH Terms

Conditions

Ulcer

Interventions

1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine

Condition Hierarchy (Ancestors)

Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Dr Sumit Rungta, DM- Medical Gastroenterology

  King George Medical University, Lucknow, UP, India

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Dr Sumit Rungta, DM- Medical Gastroenterology

CONTACT

+919935537944; drsumitrungta79@gmail.com

Dr Sayan Malakar, DM- Medical Gastroenterology

CONTACT

+919007057890; oneandonludrsayan@gmail.com

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor (Doctor)

Model Details: Parallel group randomized controlled trial

Study Record Dates

• First Submitted: April 8, 2026
• First Posted: May 27, 2026
• Study Start: May 1, 2026
• Primary Completion: July 31, 2026
• Study Completion: July 31, 2026
• Last Updated: May 27, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

IN (1)