Hoshino Shintaro, Kawami Noriyuki, Takenouchi Nana, Umezawa Mariko, Hanada Yuriko, Hoshikawa Yoshimasa, Kawagoe Tetsuro, Sano Hirohito, Hoshihara Yoshio, Nomura Tsutomu, Iwakiri Katsuhiko
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.
Digestion. 2017;95(2):156-161. doi: 10.1159/000456072. Epub 2017 Feb 11.
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.
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.
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.
VPZ was effective for most patients with PPI-resistant RE.
沃克（VPZ）是一种新型钾离子竞争性酸阻滞剂，可能对质子泵抑制剂（PPI）难治性反流性食管炎（RE）具有临床益处。本研究的目的是调查20mg VPZ治疗4周对PPI难治性RE患者的疗效，以及10mg VPZ维持治疗8周对已成功治疗患者的疗效。
研究对象包括24例PPI难治性RE患者（洛杉矶分级A/B/C/D级：3/7/11/3）。经内镜确认PPI难治性RE后，给予20mg VPZ。VPZ开始给药4周后进行内镜检查。使用胃食管反流病症状频率量表（FSSG）评估症状。给予10mg VPZ进行维持治疗，8周后进行内镜检查。
24例患者中有21例（87.5%）食管黏膜破损通过20mg VPZ成功治愈。VPZ开始给药后第1 - 7天、14天和28天的FSSG评分中位数显著低于给药前。10mg VPZ维持治疗使21例患者中的16例（76.2%）食管黏膜破损未复发。
VPZ对大多数PPI难治性RE患者有效。
