Does the Novel Potassium-Competitive Acid Blocker Vonoprazan Cause More Hypergastrinemia than Conventional Proton Pump Inhibitors? A Multicenter Prospective Cross-Sectional Study

Abstract

Background/Aim: The long-term administration of proton pump inhibitors (PPIs) is useful for preventing recurrent reflux esophagitis. On the other hand, several adverse reactions, such as an increase in the blood gastrin level, have been reported. The aim of the present study was to examine the increase in the blood gastrin level due to the long-term administration of conventional PPIs compared with vonoprazan. Methods: A prospective cross-sectional study was conducted. We examined the blood gastrin levels of patients taking vonoprazan or conventional PPIs in whom the grade of atrophic gastritis had been endoscopically evaluated in the last year. Results: The blood gastrin level was significantly higher in the vonoprazan group than that in the PPI group in patients with milder or no atrophic gastritis, irrespective of the administration periods. However, no significant difference was observed between the groups in patients with severe atrophic gastritis. Conclusion: Vonoprazan more markedly increased the blood gastrin level compared with conventional PPIs in patients with milder or no atrophic gastritis. This indicates that vonoprazan may have stronger acid-suppressing effects in such patients than conventional PPIs. Key Message: We should be aware of the potential development of hypergastrinemia during the long-term administration of vonoprazan, especially in patients with mild or no atrophic gastritis.

Pilot Study Indicates Helicobacter pylori Infection May Induce Small Intestinal Mucosal Injury

“…Although PPI induces small intestinal dysbiosis, the potassium-competitive acid blocker vonoprazan, which was recently released, is an even stronger acid suppressant [19]. There is a need to observe the influence of vonoprazan on the small intestine with caution, because it was already reported that both PPI and vonoprazan induce change in intestinal bacterial flora [20].…”

Propensity score matching analysis: incidence and risk factors for “stardust” gastric mucosa, a novel gastric finding potentially induced by vonoprazan

“…10,11,24,25 Patients who receive vonoprazan have significantly higher gastrin levels than those who receive PPIs. 10,11 Hypergastrinaemia associated with vonoprazan may affect the gastric mucosa. A study in mice showed that long-term hypergastrinaemia caused elongation of gastric pits.…”

“…9,10 Vonoprazan users had higher serum gastrin levels than PPI users. 10,11 Hypergastrinaemia may be a potential risk for neuroendocrine tumours 12 ; nonetheless, no cases of neuroendocrine tumour caused by vonoprazan-associated hypergastrinaemia have been reported. Long-term PPI therapy can result in fundic gland polyps, gastric black spots, white flat elevated mucosa and cobblestone-like mucosa.…”

Role of Acid Suppression in Acid-related Diseases: Proton Pump Inhibitor and Potassium-competitive Acid Blocker

“…73,74 Serum gastrin levels tended to be higher in the vonoprazan group than in the PPI group. 75,76 Although there is no evidence that hypergastrinemia induced by PPIs or P-CABs causes neuroendocrine tumors in humans, P-CAB-induced stimulation of enterochromaffin cells and increased risk of neuroen-docrine tumors remained. Bone fracture, hypomagnesemia, pneumonia, and C. difficile-associated diarrhea may also be caused by strong inhibition of gastric acid by continuous P-CABs treatment.…”