Second Department of Internal Medicine, Osaka Medical Collage, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-0801, Japan.
Premier Developmental Research of Medicine, Osaka Medical Collage, Osaka, Japan.
Dig Dis Sci. 2018 Apr;63(4):974-981. doi: 10.1007/s10620-018-4948-0. Epub 2018 Feb 21.
Vonoprazan exhibits a more potent, rapid, and longer-lasting inhibitory effect on gastric acid secretion than proton pump inhibitors; however, whether it is more effective than PPI for treating endoscopic submucosal dissection (ESD)-induced artificial ulcers remains controversial.
This study aimed to assess and compare the effects of vonoprazan and lansoprazole for treating ESD-induced artificial ulcers.
This prospective, randomized controlled trial enrolled 149 patients who underwent ESD for the treatment of early gastric neoplasms from April 2015 to May 2017. They were randomly treated with either 20 mg/day vonoprazan (V group) or 30 mg/day lansoprazole (L group) orally. The primary end points were the area and shrinkage ratio of the ulcers at 4 and 8 weeks post-ESD.
Data from 127 patients were analyzed, which showed that the 4- and 8-week healing ratios were not significantly different between the V and L groups (4 weeks, 16.3 vs. 25.8%; 8 weeks, 86.9 vs. 90.9%, respectively). Similarly, the shrinkage ratio, categorized as less than 90%, 90% or more but less than 100%, or 100% at 4 weeks and as less than 100% or 100% at 8 weeks were not statistically different between the V and L groups (4 weeks: 12, 41, 8 vs. 13, 41, 12, p = 0.7246; 8 weeks: 9, 52 vs. 9, 57, p = 0.8568). Delayed bleeding was also not significantly different between both the groups (5.4 vs. 5.3%; p = 0.9844).
Vonoprazan is as effective as lansoprazole in treating ESD-induced ulcers.
沃诺拉赞对胃酸分泌的抑制作用比质子泵抑制剂更强、更快、持续时间更长；然而，其在治疗内镜黏膜下剥离术（ESD）所致人工溃疡方面是否优于 PPI 仍存在争议。
本研究旨在评估和比较沃诺拉赞与兰索拉唑治疗 ESD 所致人工溃疡的效果。
本前瞻性、随机对照试验纳入了 2015 年 4 月至 2017 年 5 月因早期胃癌接受 ESD 治疗的 149 例患者。他们被随机分为沃诺拉赞（20mg/天，V 组）或兰索拉唑（30mg/天，L 组）口服治疗。主要终点是 ESD 后 4 周和 8 周时溃疡的面积和缩小率。
127 例患者的数据进行了分析，结果显示 V 组和 L 组 4 周和 8 周的愈合率无显著差异（4 周分别为 16.3%和 25.8%；8 周分别为 86.9%和 90.9%）。同样，4 周时溃疡的缩小率<90%、90%~<100%、100%和 8 周时<100%或 100%在 V 组和 L 组之间也无统计学差异（4 周：12、41、8 与 13、41、12，p=0.7246；8 周：9、52 与 9、57，p=0.8568）。两组的迟发性出血也无显著差异（5.4%与 5.3%；p=0.9844）。
沃诺拉赞治疗 ESD 所致溃疡的效果与兰索拉唑相当。
