Inclusion Criteria:  Undergoing TIPS creation as part of routine clinical care On PPIs therapy (at least 20 mg omeprazole equivalent daily) Provision of signed and dated informed consent form by participant or legal representative Stated willingness to comply with all study procedures and availability for the duration of the study Male or female, age greater or equal to 18  Exclusion Criteria:  Grade IV esophagitis or gastric or duodenal ulcer Recent endoscopic esophageal variceal band ligation necessitating PPI therapy for prevention of banding ulcer Zollinger-Ellison syndrome Active Helicobacter pylori infection Pregnancy