Efficacy of Vonoprazan for Proton Pump Inhibitor-Resistant Reflux Esophagitis

Hoshino, Shintaro; Kawami, Noriyuki; Takenouchi, Nana; Umezawa, Mariko; Hanada, Yuriko; Hoshikawa, Yoshimasa; Kawagoe, Tetsuro; Sano, Hirohito; Hoshihara, Yoshio; Nomura, Tsutomu; Iwakiri, Katsuhiko

doi:10.1159/000456072

Cited by 90 publications

(88 citation statements)

References 17 publications

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“…The present study shows that vonoprazan 10 mg daily resulted in a 100% improvement and 83% resolution of the GERD symptoms in patients with erosions. A recent Japanese study reported an 88% (21/24) endoscopic healing rate by vonoprazan 20 mg daily for four weeks in patients with PPI-resistant reflux esophagitis (7). The healing rate is similar to the resolution rate of GERD symptom in the present study.…”

Section: Discussionsupporting

confidence: 88%

“…The healing rate is similar to the resolution rate of GERD symptom in the present study. Baseline LA classifications were mainly grade B or greater (21/24, 88%) in their study (7) and 83% (5/6) in the present study. A moderate or severe LA grade may exist frequently in patients with PPI-resistant reflux esophagitis.…”

Section: Discussioncontrasting

confidence: 38%

“…Hoshino et al (7) reported the effect of vonoprazan 20 mg on patients with PPI-resistant reflux esophagitis with an 87.5% endoscopic healing rate and 76.2% of these patients did not recur even with a decreased dose of vonoprazan to 10 mg. These data encouraged us to evaluate the effect of vonoprazan 10 mg on GERD symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Vonoprazan 10 mg daily is effective for the treatment of patients with proton pump inhibitor-resistant gastroesophageal reflux disease

Shinozaki¹,

Osawa

Hayashi

et al. 2017

Biomedical Reports

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Abstract. Gastroesophageal reflux disease (GERD) is commonly treated by primary care physicians. Although proton pump inhibitors (PPI) have been the mainstay of GERD treatment for two decades, in some patients GERD is refractory to standard dose PPI for more than eight weeks and is referred to as PPI-resistant GERD. Vonoprazan, a novel competitive acid blocker, became available in Japan for the treatment of patients with GERD, and has greater acid inhibition than existing PPIs. The aim of the present study was to determine the effect of vonoprazan 10 mg daily on PPI-resistant GERD. We retrospectively reviewed 24 patients with PPI-resistant GERD treated with vonoprazan 10 mg daily. The Izumo scale was used to evaluate the effect of vonoprazan before and one month after treatment, which reflects quality of life related to gastrointestinal symptoms. The overall rates of improvement and resolution of GERD symptoms were 88% (21/24) and 42% (10/24), respectively, and the score was significantly decreased (before 5.8±1.7, at one month 1.9±1.9, P<0.001). To evaluate the influence of esophageal erosions despite prior PPI treatment, the patients were divided into erosive (n=6) and non-erosive groups (n=18). Vonoprazan achieved 100% (6/6) improvement in the erosive group and 83% (15/18) in the nonerosive group. Patients in the erosive group had a significantly higher rate of resolution than in the non-erosive group [83% (5/6) vs 28% (5/18), P=0.017]. No adverse events occurred. Other GI symptoms in patients with PPI-resistant GERD were evaluated. The scores for epigastric pain, postprandial distress, constipation and diarrhea were unchanged during the treatment period. In conclusion, vonoprazan 10 mg daily is effective for the treatment of patients with PPI-resistant GERD. Vonoprazan resolves GERD symptoms in patients with erosions more than in those without erosions. This is the first report on the effect of vonoprazan 10 mg on PPI-resistant GERD.

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Section: Discussionsupporting

confidence: 88%

Section: Discussioncontrasting

confidence: 38%

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Vonoprazan 10 mg daily is effective for the treatment of patients with proton pump inhibitor-resistant gastroesophageal reflux disease

Shinozaki¹,

Osawa

Hayashi

et al. 2017

Biomedical Reports

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“…Changes in the gastric pH after a single 20 mg administration of vonoprazan suggest that it is the optimal agent for on-demand therapy for reflux symptoms. Although the efficacy of vonoprazan for PPI-resistant RE has been reported [13, 14, 15], no results of on-demand therapy for mild RE using vonoprazan at 20 mg have been reported. Moreover, the problem of hypergastrinemia caused by long-term use of vonoprazan may be resolved by on-demand therapy.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of On-Demand Therapy Using 20-mg Vonoprazan for Mild Reflux Esophagitis

Umezawa¹,

Kawami²,

Hoshino³

et al. 2018

Digestion

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Background: The study aimed to evaluate the efficacy of on-demand therapy using 20-mg vonoprazan for mild reflux esophagitis (RE). Methods: On-demand therapy by taking one 20-mg tablet of vonoprazan only when reflux symptoms occurred was performed for 24 weeks using 30 patients with mild RE who were receiving maintenance therapy with proton pomp inhibitors (PPIs). The presence or absence of RE, degree of overall satisfaction with the treatment, score of symptoms, and fasting gastrin level before breakfast were examined before and after on-demand therapy. The number of tablets taken during the 24-week period was also noted. Results: One of the 30 patients dropped out of on-demand therapy 1 week after its initiation. Remission was maintained in 25 (86.2%) of the 29 patients (all 10 [100%] Los Angeles classification grade A patients and 15 (78.9%) of the 19 grade B patients). However, 4 grade B patients exhibited grade B relapse. There were no differences in the degree of overall satisfaction, score of symptoms or the gastrin level between PPI and on-demand therapies. The number of vonoprazan tablets taken during the observation period was 33 tablets (median)/24 weeks. Conclusion: On-demand therapy using 20-mg vonoprazan tablets is an effective alternative maintenance therapy for mild RE.

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“…The definition of PPI-resistant GERD should be modified after the launching of potent potassium-competitive acid blockers such as vonoprazan [43][44][45][46][47], the evaluation of other therapeutic agents for PPI-resistant GERD as monotherapy and add-on therapy to PPI or potassium-competitive acid blockers should be re-evaluated. One speaker talked about the efficacy of hangeshashinto for PPI-resistant reflux symptoms, while the other speaker talked about the efficacy of acotiamide for treating FD and other FGIDs (unpublished data).…”

Section: Core Symposium 3 Of the 13th Annual Meeting Of The Jga (2017)mentioning

confidence: 99%

New Medical Approach to Functional Dyspepsia, from Core Symposium 3, Japan Gastroenterological Association 2015–2017

Suzuki¹

2018

Digestion

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In the annual meeting of the Japan Gastroenterological Association (JGA), the scientific organizing committee selected the serial topics for the core symposium. One of the core symposia held during 2015-2017 was entitled "New medical approach to functional dyspepsia (FD)." In 2015, the subtitle of this symposium was "Helicobacter pylori gastritis and FD." In 2016, the subtitle of this symposium was "overlap with other functional GI disorders." In 2017, the subtitle was "therapeutic approach to FD." During these 3 years, a total of 24 presentations were included in Core Symposium 3 and deep and intensive discussions were carried out.

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Efficacy of Vonoprazan for Proton Pump Inhibitor-Resistant Reflux Esophagitis

Cited by 90 publications

References 17 publications

Vonoprazan 10 mg daily is effective for the treatment of patients with proton pump inhibitor-resistant gastroesophageal reflux disease

Vonoprazan 10 mg daily is effective for the treatment of patients with proton pump inhibitor-resistant gastroesophageal reflux disease

Efficacy of On-Demand Therapy Using 20-mg Vonoprazan for Mild Reflux Esophagitis

New Medical Approach to Functional Dyspepsia, from Core Symposium 3, Japan Gastroenterological Association 2015–2017

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