Abstract
Background: Vonoprazan (VPZ) is a novel potassium-competitive acid blocker that may be clinically beneficial for proton pump inhibitor (PPI)-resistant reflux esophagitis (RE). The aim of this study was to investigate the efficacies of VPZ therapy at 20 mg for 4 weeks in patients with PPI-resistant RE and VPZ maintenance therapy at 10 mg for 8 weeks in patients who have been successfully treated. Methods: Subjects comprised 24 patients with PPI-resistant RE (Los Angeles classification grade A/B/C/D: 3/7/11/3). After confirming PPI-resistant RE by endoscopy, 20 mg VPZ was administered. Endoscopy was performed 4 weeks after the initiation of VPZ. Symptoms were evaluated using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG). Maintenance therapy with 10 mg VPZ was performed and endoscopy was conducted after 8 weeks. Results: In 21 (87.5%) out of 24 patients, esophageal mucosal breaks were successfully treated by 20 mg VPZ. The median FSSG score was significantly lower on days 1-7, 14, and 28 after the initiation of VPZ than before its administration. Maintenance therapy with 10 mg VPZ prevented the relapse of esophageal mucosal breaks in 16 (76.2%) out of 21 patients. Conclusion: VPZ was effective for most patients with PPI-resistant RE.
Journal Section:
Original Paper
References
1.
Ariizumi K, Ohara S, Koike T, Inomata Y, Iijima K, Sekine H, Noguchi M, Sugiyama K, Eda Y, Kayaba S, Kawamura M, Shimosegawa T: Therapeutic effects of 10 mg/day rabeprazole administration on reflux esophagitis was not influenced by the CYP2C19 polymorphism. J Gastroenterol Hepatol 2006;21:1428-1434.
[PubMed]
2.
Kinoshita Y, Miwa H, Kasugai K: [Efficacy and safety of esomeprazole, compared with omeprazole, in maintenance therapy for reflux esophagitis -a phase III, multicenter, randomized, double-blind trial-]. Nihon Shokakibyo Gakkai Zasshi 2013;110:1428-1438.
[PubMed]
3.
Mizuno H, Matsuhashi N, Sakaguchi M, Inoue S, Nakada K, Higuchi K, Haruma K, Joh T: Recent effectiveness of proton pump inhibitors for severe reflux esophagitis: the first multicenter prospective study in Japan. J Clin Biochem Nutr 2015;57:233-238.
[PubMed]
4.
Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L: Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45:172-180.
[PubMed]
5.
Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y, Nagahara A, Kawamura O, Iwakiri R, Ozawa S, Ashida K, Ohara S, Kashiwagi H, Adachi K, Higuchi K, Miwa H, Fujimoto K, Kusano M, Hoshihara Y, Kawano T, Haruma K, Hongo M, Sugano K, Watanabe M, Shimosegawa T: Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol 2016;51:751-767.
[PubMed]
6.
Jenkins H, Sakurai Y, Nishimura A, Okamoto H, Hibberd M, Jenkins R, Yoneyama T, Ashida K, Ogama Y, Warrington S: Randomised clinical trial: safety, tolerability, pharmacokinetics and pharmacodynamics of repeated doses of TAK-438 (vonoprazan), a novel potassium-competitive acid blocker, in healthy male subjects. Aliment Pharmacol Ther 2015;41:636-648.
[PubMed]
7.
Sakurai Y, Mori Y, Okamoto H, Nishimura A, Komura E, Araki T, Shiramoto M: Acid-inhibitory effects of vonoprazan 20 mg compared with esomeprazole 20 mg or rabeprazole 10 mg in healthy adult male subjects - a randomised open-label cross-over study. Aliment Pharmacol Ther 2015;42:719-730.
[PubMed]
8.
Ashida K, Sakurai Y, Nishimura A, Kudou K, Hiramatsu N, Umegaki E, Iwakiri K, Chiba T: Randomised clinical trial: a dose-ranging study of vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the treatment of erosive oesophagitis. Aliment Pharmacol Ther 2015;42:685-695.
[PubMed]
9.
Ashida K, Sakurai Y, Hori T, Kudou K, Nishimura A, Hiramatsu N, Umegaki E, Iwakiri K: Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther 2016;43:240-251.
[PubMed]
10.
Kimura K, Takemoto T: An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969;1:87-97.
11.
Kusano M, Shimoyama Y, Sugimoto S, Kawamura O, Maeda M, Minashi K, Kuribayashi S, Higuchi T, Zai H, Ino K, Horikoshi T, Sugiyama T, Toki M, Ohwada T, Mori M: Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol 2004;39:888-891.
[PubMed]
12.
Bell NJ, Burget D, Howden CW, Wilkinson J, Hunt RH: Appropriate acid suppression for the management of gastro-oesophageal reflux disease. Digestion 1992;51(suppl 1):59-67.
[PubMed]
13.
Mittal RK, Lange RC, McCallum RW: Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia. Gastroenterology 1987;92:130-135.
[PubMed]
14.
Shimatani T, Inoue M, Kuroiwa T, Xu J, Mieno H, Nakamura M, Tazuma S: Acid-suppressive effects of rabeprazole, omeprazole, and lansoprazole at reduced and standard doses: a crossover comparative study in homozygous extensive metabolizers of cytochrome P450 2C19. Clin Pharmacol Ther 2006;79:144-152.
[PubMed]
15.
Röhss K, Wilder-Smith C, Nauclér E, Jansson L: Esomeprazole 20mg provides more effective intragastric acid control than maintenance-dose rabeprazole, lansoprazole or pantoprazole in healthy volunteers. Clin Drug Investig 2004;24:1-7.
[PubMed]
16.
Norris V, Baisley K, Dunn K, Warrington S, Morocutti A: Combined analysis of three crossover clinical pharmacology studies of effects of rabeprazole and esomeprazole on 24-h intragastric pH in healthy volunteers. Aliment Pharmacol Ther 2007;25:501-510.
[PubMed]
17.
Yamasaki H, Kawaguchi N, Nonaka M, Takahashi J, Morohashi A, Hirabayashi H, Moriwaki T, Asahi S: In vitro metabolism of TAK-438, vonoprazan fumarate, a novel potassium-competitive acid blocker. Xenobiotica 2016:1-8.
[PubMed]
© 2017 S. Karger AG, Basel
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