Asaoka Daisuke, Nagahara Akihito, Hojo Mariko, Matsumoto Kenshi, Ueyama Hiroya, Matsumoto Kohei, Izumi Kentaro, Takeda Tsutomu, Komori Hiroyuki, Akazawa Yoichi, Shimada Yuji, Osada Taro, Watanabe Sumio
Department of Gastroenterology, University of Juntendo, School of Medicine, Tokyo 113-8421, Japan.
Department of Gastroenterology, Juntendo University Shizuoka Hospital, Shizuoka 410-2295, Japan.
Biomed Rep. 2017 Feb;6(2):175-180. doi: 10.3892/br.2016.828. Epub 2016 Dec 15.
The aim of the present study was to investigate the efficacy of a potassium-competitive acid blocker (PCAB) named vonoprazan (VPZ) for improving symptoms in patients with reflux esophagitis (RE), non-erosive reflux disease (NERD), and functional dyspepsia (FD). A hospital-based, retrospective study of outpatients in our department (Department of Gastroenterology, University of Juntendo, Tokyo, Japan) between March 2015 and August 2016 was performed. The patients who were experiencing heartburn, acid regurgitation, gastric pain, and/or a heavy feeling in the stomach of at least moderate severity at baseline were treated with 20 mg VPZ once daily for 4 weeks. The patients completed the global overall symptom (GOS) scale to determine their symptom severity at baseline and after the 4 week treatment period. The proportions of patients with RE, NERD, and FD achieving improvement of their symptoms, defined as a GOS scale score of 1 ('no problem') or 2 ('minimal problem'), were evaluated. During 4 weeks of VPZ therapy, changes in the gastroesophageal reflux disease (GERD) score, which was defined as the total points for heartburn and acid regurgitation on the GOS scale in patients with RE and NERD, and in the FD score, which was defined as the total points for gastric pain and a heavy feeling in the stomach on the GOS scale in patients with FD, were also evaluated. A total of 88 eligible cases were included in the present study, comprising 20 patients with RE, 25 patients with NERD, and 43 patients with FD. The rates of symptomatic improvement in patients with RE, NERD, and FD were 75.0, 60.0, and 48.8%, respectively. For the patients who were first administered VPZ, the rates of symptomatic improvement were 90.9, 66.7, and 58.8% in patients with RE, NERD, and FD, respectively. For those patients who were resistant to 8 weeks of proton pump inhibitor therapy, the rates of symptomatic improvement were 55.6, 53.8, and 42.3% in patients with RE, NERD, and FD, respectively. The GERD score in patients with RE and NERD, and the FD score in FD patients, were decreased after 4 weeks of VPZ therapy (P<0.01). In patients with RE, NERD and FD, the possibility that PCAB may be used as a novel therapeutic drug was suggested. However, the number of study subjects was small; therefore, further, larger and prospective studies are required.
本研究的目的是调查一种名为沃克（VPZ）的钾离子竞争性酸阻滞剂对改善反流性食管炎（RE）、非糜烂性反流病（NERD）和功能性消化不良（FD）患者症状的疗效。对2015年3月至2016年8月期间日本东京顺天堂大学胃肠病学系门诊患者进行了一项基于医院的回顾性研究。基线时出现烧心、反酸、胃痛和/或至少中度严重程度的胃部沉重感的患者，每天服用20mg VPZ，持续4周。患者完成全球总体症状（GOS）量表，以确定其在基线和4周治疗期后的症状严重程度。评估RE、NERD和FD患者症状改善的比例，症状改善定义为GOS量表评分为1（“无问题”）或2（“最小问题”）。在VPZ治疗的4周内，还评估了胃食管反流病（GERD）评分的变化，GERD评分定义为RE和NERD患者GOS量表上烧心和反酸的总分；以及FD评分的变化，FD评分定义为FD患者GOS量表上胃痛和胃部沉重感的总分。本研究共纳入88例符合条件的病例，包括20例RE患者、25例NERD患者和43例FD患者。RE、NERD和FD患者的症状改善率分别为75.0%、60.0%和48.8%。对于首次服用VPZ的患者，RE、NERD和FD患者的症状改善率分别为90.9%、66.7%和58.8%。对于那些对8周质子泵抑制剂治疗耐药的患者，RE、NERD和FD患者的症状改善率分别为55.6%、53.8%和42.3%。VPZ治疗4周后，RE和NERD患者的GERD评分以及FD患者的FD评分均降低（P<0.01）。在RE、NERD和FD患者中，提示PCAB可能作为一种新型治疗药物的可能性。然而，研究对象数量较少；因此，需要进一步开展更大规模的前瞻性研究。
