Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan,
Department of Medicine and Molecular Science, Gunma University, Maebashi, Japan,
Digestion. 2020;101(2):174-183. doi: 10.1159/000497775. Epub 2019 Mar 21.
BACKGROUND/AIM: We evaluated the efficacy of vonoprazan (VPZ), a novel potassium-competitive acid blocker, in patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD), exhibiting continued pathological esophageal acid exposure (EAE).
Despite ≥8 weeks of appropriate PPI therapy, patients with -persistent reflux symptoms and pathological EAE times (EAETs ≥4%) were invited to switch to VPZ treatment. After an 8-week-course of once-daily VPZ (20 mg), multichannel intraluminal impedance-pH (MII-pH) monitoring was repeated to compare gastric acid exposure times (GAETs), EAETs, and other reflux parameters relative to the baseline values. Before each MII-pH study, reflux symptom severities were scored using the Gastrointestinal Symptom Rating Scale; erosive esophagitis and fasting plasma gastrin levels were also assessed.
From among the 124 patients undergoing MII-pH monitoring, 13 patients (median age, 69 years; females, 64%) were monitored at baseline (while on PPI therapy) and after VPZ therapy. The median GAET associated with VPZ treatment (23.8%) was less than that for PPI treatment (41.1%; p = 0.01), including both daytime and nighttime measurements. VPZ therapy resulted in better median EAET values (4.5%) than did PPI therapy (10.6%) during the 24-h monitoring period (p = 0.055). EAE normalization was achieved in 46% of VPZ-treated patients and was associated with complete gastric acid suppression (p = 0.005). After switching to VPZ, reflux symptoms (p < 0.01) and erosive esophagitis (p = 0.01) improved.
In patients with PPI-refractory GERD, VPZ provides more potent gastric acid suppression, more effective EAE control, enhanced symptom improvement, and better esophagitis healing than PPIs.
背景/目的：我们评估了新型钾竞争性酸阻滞剂沃诺拉赞（VPZ）在质子泵抑制剂（PPI）难治性胃食管反流病（GERD）患者中的疗效，这些患者表现为持续的病理性食管酸暴露（EAE）。
尽管接受了≥8 周的适当 PPI 治疗，但仍有持续性反流症状和病理性 EAE 时间（EAETs≥4%）的患者被邀请转为 VPZ 治疗。在接受为期 8 周的每日一次 VPZ（20mg）治疗后，重复进行多通道腔内阻抗-pH（MII-pH）监测，以比较胃酸暴露时间（GAETs）、EAETs 和其他反流参数与基线值的关系。在每次 MII-pH 研究之前，使用胃肠道症状评分量表（Gastrointestinal Symptom Rating Scale）评估反流症状严重程度；还评估了糜烂性食管炎和空腹血浆胃泌素水平。
在接受 MII-pH 监测的 124 例患者中，有 13 例（中位年龄 69 岁；女性 64%）在基线时（接受 PPI 治疗时）和 VPZ 治疗后进行了监测。VPZ 治疗时的中位 GAET（23.8%）低于 PPI 治疗时的 GAET（41.1%；p=0.01），包括日间和夜间测量。在 24 小时监测期间，VPZ 治疗的中位 EAET 值（4.5%）优于 PPI 治疗（10.6%）（p=0.055）。VPZ 治疗组有 46%的患者 EAE 正常化，与完全抑制胃酸有关（p=0.005）。转换为 VPZ 后，反流症状（p<0.01）和糜烂性食管炎（p=0.01）得到改善。
在 PPI 难治性 GERD 患者中，VPZ 提供了比 PPI 更强的胃酸抑制作用、更有效的 EAE 控制、更显著的症状改善和更好的食管炎愈合效果。
