Vonoprazan treatment improves gastrointestinal symptoms in patients with gastroesophageal reflux disease

Abstract

The effects of vonoprazan, a new potassium-competitive acid blocker, on gastroesophageal reflux disease (GERD) symptom are not fully elucidated. The aim of this study is to determine the effect of vonoprazan on GERD and associated gastrointestinal symptoms. We retrospectively reviewed 88 Helicobacter pylori negative patients with GERD treated with vonoprazan 10 mg daily. Symptoms were evaluated using the Izumo scale, which reflects quality of life related to various abdominal symptoms. The rates of improvement and resolution of GERD symptoms were 86% (76/88) and 57% (50/88), respectively. Improvement and resolution in patients with erosive esophagitis was higher than in those with non-erosive reflux disease (91% vs 83%, p = 0.260 and 71% vs 47%, p = 0.025, respectively). We attempted to identify factors which predict the effects of vonoprazan. Multivariate analysis identified advanced age (≥60-year-old) (odds ratio [OR] 7.281, 95% confidence interval [CI] 2.056-25.776, p = 0.002), obesity (BMI ≥ 24) (OR 3.342, 95%CI 1.124-9.940, p = 0.030) and erosive esophagitis (OR 4.368, 95%CI 1.281-14.895, p = 0.018) as positive predictors of resolution of GERD symptoms. Alcohol use (OR 0.131, 95%CI 0.027-0.632, p = 0.011) and history of H. pylori eradication (OR 0.171, 95%CI 0.041-0.718, p = 0.015) were identified as negative predictors. Vonoprazan also improved epigastric pain (73%), postprandial distress (60%), constipation (58%) and diarrhea (52%) in patients with GERD. In conclusion, vonoprazan 10 mg daily is effective in improving GERD symptoms. Advanced age, obesity, erosive esophagitis, alcohol use and history of H. pylori eradication influence the resolution of GERD symptoms. Treatment with vonoprazan favorably affects gastrointestinal symptoms in patients with GERD.

Efficacy of vonoprazan for initial and maintenance therapy in reflux esophagitis, nonerosive esophagitis, and proton pump inhibitor-resistant gastroesophageal reflux disease

“…Furthermore, functional heart burn, which mainly occurs because of the hyperesthesia of the esophageal mucosa and psychological factors of patient, may exist in nonerosive group. Shinozaki et al [ 33 ] have reported that improvement and resolution rates in the nonerosive PPI-resistant GERD were 83% and 28%, respectively, even when taking VPZ 10 mg daily. This data was in accordance to that from the present study.…”

Potassium-competitive acid blockers - are they the next generation of proton pump inhibitors?

“…Vonoprazan is an acid-stable and fast absorbing drug approved for the treatment of reflux esophagitis for prevention of relapse[7]. In GERD, vonoprazan improves epigastric pain, postprandial distress, constipation, and diarrhea[8]. Linaprazan (AZD8065) has shown similar efficacy as esomeprazole in healing and preventing symptoms of GERD with EE; however, it has not shown any benefit in patients with NERD.…”

New pharmacological treatments for gastroesophageal reflux: Potassium-competitive acid blockers and bile acid sequestrants

“…VPZ treatment was shown to improve gastrointestinal symptoms in patients with GERD 24 . Shinozaki et al retrospectively analyzed 24 patients with PPI-resistant GERD treated with 10 mg VPZ.…”

“…In addition, VPZ 10 mg was shown to be effective and resolved GERD symptoms in patients with erosions more than in those without erosions 26 . They also retrospectively reviewed 88 H. pylori-negative patients with GERD treated with VPZ 10 mg 24 . The rates of symptomatic improvement and resolution of GERD were 86% and 57%, respectively.…”