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

Yoshizaki, Tetsuya; Morisawa, Toshiyuki; Fujinami, Maho; Matsuda, Tatsuya; Katayama, Norio; Inoue, Kazuki; Matsumoto, Masanori; Ikeoka, Seitaro; Takagi, M.; Sako, Tomoya; Momose, Kazutaka; Noda, Mari; Eguchi, Takaaki; Okada, Akihiko

doi:10.1111/apt.16151

Cited by 15 publications

(11 citation statements)

References 28 publications

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“…97 However, a case of foveolar-type gastric adenocarcinoma has recently been reported in a male patient with EE after a 156-week maintenance therapy of vonoprazan 10 mg daily. 98 In addition, gastric mucosal redness, ‘stardust gastric mucosa’, and white globe appearance can be observed in patients taking vonoprazan, 99–101 but they are not of major clinical significance. Other common AEs were infrequent, and their incidences were similar to that of PPIs.…”

Section: Discussionmentioning

confidence: 99%

Incidence and type of adverse events in patients taking vonoprazan: A systematic review and meta-analysis

Bai

Shang

et al. 2023

Therap Adv Gastroenterol

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Background: Vonoprazan, a novel acid-suppressive drug, is non-inferior to proton pump inhibitors (PPIs) for the management of gastric acid-related diseases. However, the safety of vonoprazan has not been systematically evaluated yet. Objectives: To elucidate the incidence and type of adverse events (AEs) in patients taking vonoprazan. Design: Systematic review and meta-analysis. Data sources and methods: PubMed, EMBASE, and Cochrane Library databases were searched for all studies reporting the safety of vonoprazan. The incidences of any AEs, drug-related AEs, serious AEs, AEs leading to drug discontinuation, and common AEs were pooled. Odds ratios (ORs) were calculated to compare the incidence of AEs between patients taking vonoprazan and PPIs. Results: Seventy-seven studies were included. The pooled incidences of any AEs, drug-related AEs, serious AEs, and AEs leading to drug discontinuation were 20, 7, 1, and 1%, respectively. The incidences of any AEs (OR = 0.96, p = 0.66), drug-related AEs (OR = 1.10, p = 0.44), serious AEs (OR = 1.14, p = 0.36), and AEs leading to drug discontinuation (OR = 1.09, p = 0.55) were not significantly different between patients taking vonoprazan and PPIs. In subgroup analyses, patients with peptic ulcer disease (PUD) had higher incidences of any AEs, serious AEs, and AEs leading to drug discontinuation than those with gastroesophageal reflux disease (GERD), Helicobacter pylori ( H. pylori) infection, and artificial ulcer after gastric endoscopic submucosal dissection (ESD), but patients with H. pylori infection had a higher incidence of drug-related AEs than those with PUD, GERD, and artificial ulcer after gastric ESD. The incidence of AEs was higher in patients taking long-term use of vonoprazan than those taking short-term use of vonoprazan. Conclusion: Vonoprazan is well tolerated and shows similar safety compared to PPIs. The safety of vonoprazan may be primarily influenced by its indications and duration. Registration: PROSPERO CRD42022314982.

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Section: Discussionmentioning

confidence: 99%

Incidence and type of adverse events in patients taking vonoprazan: A systematic review and meta-analysis

Bai

Shang

et al. 2023

Therap Adv Gastroenterol

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“… 59 , 60 After the release of VPZ, the presence of multiple small white protrusions, located within the fundus and corpus as observed at esophagogastroduodenoscopy was reported in 2020 by Yoshizaki et al. 58 Due to its appearance, this was termed ‘stardust gastric mucosa’ (Figure 1f ). The prevalence rates in VPZ and non‐VPZ users were 4.9% and 0.2%, respectively.…”

Section: Introductionmentioning

confidence: 78%

Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy

Shinozaki,

Osawa,

Miura

et al. 2024

DEN Open

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Gastric mucosal changes associated with long‐term potassium‐competitive acid blocker and proton pump inhibitor (PPI) therapy may raise concern. In contrast to that for PPIs, the evidence concerning the safety of long‐term potassium‐competitive acid blocker use is scant. Vonoprazan (VPZ) is a representative potassium‐competitive acid blocker released in Japan in 2015. In order to shed some comparative light regarding the outcomes of gastric mucosal lesions associated with a long‐term acid blockade, we have reviewed six representative gastric mucosal lesions: fundic gland polyps, gastric hyperplastic polyps, multiple white and flat elevated lesions, cobblestone‐like gastric mucosal changes, gastric black spots, and stardust gastric mucosal changes. For these mucosal lesions, we have evaluated the association with the type of acid blockade, patient gender, Helicobacter pylori infection status, the degree of gastric atrophy, and serum gastrin levels. There is no concrete evidence to support a significant relationship between VPZ/PPI use and the development of neuroendocrine tumors. Current data also shows that the risk of gastric mucosal changes is similar for long‐term VPZ and PPI use. Serum hypergastrinemia is not correlated with the development of some gastric mucosal lesions. Therefore, serum gastrin level is unhelpful for risk estimation and for decision‐making relating to the cessation of these drugs in routine clinical practice. Given the confounding potential neoplastic risk relating to H. pylori infection, this should be eradicated before VPZ/PPI therapy is commenced. The evidence to date does not support the cessation of clinically appropriate VPZ/PPI therapy solely because of the presence of these associated gastric mucosal lesions.

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“…Miwa et al 35,36 reported a case of WS emerging after the initiation of P-CAB treatment and subsequently disappearing after transitioning to a PPI. The findings by Yoshizaki et al 32 ). This suggests an association between WS and hypergastrinemia, implying that P-CAB-related hypergastrinemia may be involved in the formation of WS.…”

Section: White Spotsmentioning

confidence: 91%

“…30,31 Histologically, WS is characterized by a dilated gland containing either eosinophilic material with necrotic epithelial fragments or a mucus pool. [30][31][32][33] Iwamuro et al 34 reported two cases of WS in P-CAB and PPI users. Miwa et al 35,36 reported a case of WS emerging after the initiation of P-CAB treatment and subsequently disappearing after transitioning to a PPI.…”

Section: White Spotsmentioning

confidence: 99%

Potassium-competitive acid blocker-associated gastric mucosal lesions

Kubo,

Kimura,

Kato

2024

Clin Endosc

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Since the introduction of vonoprazan, a potassium-competitive acid blocker (P-CAB), it has been demonstrated to reversibly inhibit gastric acid secretion by engaging in potassium-competitive ionic binding to H + /K + -ATPase. In contrast, proton pump inhibitors (PPIs) achieve H + /K + -ATPase inhibition through covalent binding to cysteine residues of the proton pump. Reported cases have indicated an emerging trend of P-CAB-related gastropathies, similar to those associated with PPIs, as well as unique gastropathies specific to P-CAB use, such as the identification of web-like mucus. Pathologically, parietal cell profusions, which show a positively correlated with hypergastrinemia, have a higher incidence in P-CAB users compared to PPI users. Thus, this review aims to summarize the endoscopic and pathological findings reported to date concerning P-CAB-related gastric mucosal lesions. Additionally, it seeks to discuss the differences between the PPIs and P-CABs in terms of the formation and frequency of associated gastropathies. This review highlights the evident differences in the mechanism of action and potency of acid inhibition between P-CABs and PPIs, notably contributing to differences in the formation and frequency of associated gastropathies. It emphasizes the necessity to distinguish between P-CAB-related and PPI-related gastropathies in the clinical setting.

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

Cited by 15 publications

References 28 publications

Incidence and type of adverse events in patients taking vonoprazan: A systematic review and meta-analysis

Incidence and type of adverse events in patients taking vonoprazan: A systematic review and meta-analysis

Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy

Potassium-competitive acid blocker-associated gastric mucosal lesions

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