Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan,
Digestion. 2021;102(3):480-488. doi: 10.1159/000506152. Epub 2020 Feb 14.
Weakly acidic reflux has been reported to be the major cause of symptoms in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) undergoing PPI treatment. We previously reported that reflux at pH 4-5 was the main factor that induced symptoms in such patients. The present study aimed to elucidate the symptom-ameliorating effect of vonoprazan (VPZ) by evaluating the change in the pH value of the refluxate using multichannel intraluminal impedance and pH (MII-pH) monitoring.
We retrospectively evaluated the records of MII-pH monitoring in 29 symptom index (SI) and/or symptom association probability (SAP)-positive patients with PPI-refractory NERD. After switching to VPZ 20 mg/day, we performed MII-pH monitoring again. We assessed the change in the score of the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), the pH value of the refluxate, and the percent times of intragastric pH <4 or <5 before and after switching. We divided the patients into the following 2 groups according to the FSSG score after switching: effective and noneffective groups.
Among of the 29 SI/SAP-positive patients, 16 underwent switching to VPZ. Furthermore, of these 16 patients, 10 underwent MII-pH monitoring again after switching. The FSSG score decreased, the pH value of the refluxate increased, and the percent times of intragastric pH <4 or <5 reduced after switching when compared with the findings before switching. In the effective group, both the proportion of reflux at pH <4 and that of reflux at pH 4-5 decreased while taking VPZ when compared with the findings while taking double-dose PPI. In the noneffective group, the proportion of reflux at pH <4 decreased but that of reflux at pH 4-5 increased and that of reflux at pH <5 did not change overall while taking VPZ. In addition, the percent times of intragastric pH <5 values were low in the effective group.
Symptom suppression appears to be inadequate in patients with persistent reflux at pH 4-5 even with VPZ 20 mg/day. Strong acid suppressive therapy with VPZ to increase the pH value of the refluxate to ≥5 is useful for symptom improvement.
据报道，弱酸性反流是质子泵抑制剂 (PPI) 难治性非糜烂性反流病 (NERD) 患者在接受 PPI 治疗时症状的主要原因。我们之前的研究报告称，pH 值为 4-5 的反流是引起此类患者症状的主要因素。本研究旨在通过使用多通道腔内阻抗和 pH (MII-pH) 监测评估反流物 pH 值的变化来阐明 vonoprazan (VPZ) 的症状缓解作用。
我们回顾性评估了 29 例症状指数 (SI) 和/或症状关联概率 (SAP) 阳性的 PPI 难治性 NERD 患者的 MII-pH 监测记录。在改用 VPZ 20mg/天后，我们再次进行 MII-pH 监测。我们评估了胃食管反流病症状频率量表 (FSSG) 评分、反流物 pH 值以及切换前后胃内 pH 值 <4 或 <5 的时间百分比的变化。根据切换后的 FSSG 评分，我们将患者分为以下两组：有效组和无效组。
在 29 例 SI/SAP 阳性患者中，有 16 例患者改用 VPZ。此外，在这 16 名患者中，有 10 名在改用 VPZ 后再次进行了 MII-pH 监测。与切换前相比，切换后 FSSG 评分降低，反流物 pH 值升高，胃内 pH 值 <4 或 <5 的时间百分比减少。在有效组中，与服用双倍剂量 PPI 时相比，服用 VPZ 时 pH 值 <4 的反流比例和 pH 值为 4-5 的反流比例均降低。在无效组中，虽然服用 VPZ 时 pH 值 <4 的反流比例降低，但 pH 值为 4-5 的反流比例增加，pH 值 <5 的反流比例总体上没有变化。此外，有效组的胃内 pH 值 <5 的时间百分比较低。
即使服用 20mg/天的 VPZ，持续 pH 值为 4-5 的反流患者的症状抑制似乎也不充分。使用 VPZ 进行强酸抑制治疗以将反流物 pH 值增加到≥5 对改善症状很有用。
