Background and Aims: Endoscopic variceal ligation (EVL) is a standard treatment for esophageal varices (EV). However, post-EVL ulcers may cause complications such as chest pain, dysphagia and more seriously, bleeding ulcer. Since gastric reflux can interfere esophageal ulcer healing, prevention of gastric reflux with alginate may be able to accelerate the ulcer healing and reduce ulcer complication. This study aimed to evaluate the effect of oral alginate on the healing of post-EVL ulcers and frequency of ulcer complications.

Methods: The cirrhotic patients with large EV who received first EVL were enrolled. The patients were randomly assigned to receive alginate tablet (alginic acid, aluminium hydroxide, magnesium carbonate) 2 tablets qid for 14 days or not. Follow-up endoscopy was performed at 14 days after EVL by one endoscopist who was blinded to study medication to assess number, size, and stage of residual banding ulcers (per modified Sakita-Miwa classification). We also assess symptoms using GERD-Q questionnaire. The ulcer size, stage and symptoms were compared.

Results: Thirty-six patients were included (18 in alginate group and 18 in control group). At follow-up endoscopy, there were 83 post-EVL ulcers in alginate group and 75 post-EVL ulcers in control group. The median ulcer area was significantly smaller in alginate group (5.93 vs 21.70 mm3)( p=0.001). The rate of healed ulcers (H2) and scar (S) was higher in alginate group (60.2 vs 37.3%)( p=0.007). In addition, the frequency of chest pain was significantly lower in alginate group (17.6% vs 68.8%) (p=0.005).

Conclusion: Oral alginate after EVL can accelerate healing of post-EVL ulcers and can reduce post-EVL complication such as chest pain. Larger RCTs are needed to confirm our result.

	Alginate group (n=83)	Control group (n=75)	p-value
Ulcer size (mm2)
Median ulcer area (Q1-Q3)	5.93(0.00-24.05)	21.70(4.60-36.55)	0.001
Ulcer stage (%)
A2 and H1	33(39.8%)	47(62.7%)	0.007
H2 and S1	50(60.2%)	28(37.3%)