Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Department of Gastroenterology, Nippon Medical School, Tokyo, Japan.
Dig Dis. 2021;39(6):569-576. doi: 10.1159/000515146. Epub 2021 Feb 10.
Refractory reflux esophagitis (RRE), unresponsive to conventional proton-pump inhibitors (PPIs), is a complication in esophagectomy with gastric pull-up. Vonoprazan (VPZ), a novel potassium-competitive acid blocker, has been available in Japan since 2015. Here, we investigated the efficacy of VPZ on PPI-resistant RRE after esophagectomy with gastric pull-up.
This was a single-center retrospective study. We used the revised Los Angeles (r-LA) classification based on the Los Angeles classification and the modified Los Angeles classification to evaluate abnormal forms of mucosal breaks such as lateral spreading consistently. Patients who underwent esophagectomy with gastric pull-up and had RRE grade B-D as per the r-LA classification, despite using standard-dose PPIs or double dose of rabeprazole, were included. Sixteen patients who switched to VPZ (20 mg/day) and 14 patients who continued PPIs were assigned to the VPZ and PPI groups, respectively. Endoscopic observations were reviewed by 3 endoscopists using the r-LA classification to ensure consistent diagnosis, while the treatment arm and patient information were blinded to evaluators. We defined mucosal breaks that improved by at least one grade after treatment as improved mucosa and recovery to grade M or N as mucosal healing.
The percentage of patients with improved mucosa in the VPZ and PPI groups was 81.3 and 14.3%, respectively (p < 0.001). The rate of mucosal healing was 68.8 and 7.1%, respectively (p = 0.001).
VPZ significantly improved PPI-resistant RRE after esophagectomy with gastric pull-up.
胃食管反流病（GERD）是胃食管反流手术后的一种并发症，对传统质子泵抑制剂（PPIs）反应不佳。沃诺拉赞（VPZ）是一种新型钾竞争性酸阻滞剂，自 2015 年以来在日本上市。在此，我们研究了 VPZ 对胃食管反流手术后 PPI 抵抗性 RRE 的疗效。
这是一项单中心回顾性研究。我们使用修订后的洛杉矶（r-LA）分类，基于洛杉矶分类和改良的洛杉矶分类，一致评估黏膜破损的异常形式，如侧向扩散。纳入接受胃食管反流手术后 r-LA 分类为 B-D 级的 RRE 患者，尽管使用标准剂量的 PPIs 或雷贝拉唑双倍剂量。将 16 例转换为 VPZ（20mg/天）的患者和 14 例继续使用 PPIs 的患者分别分配到 VPZ 和 PPI 组。3 名内镜医生使用 r-LA 分类对内镜观察结果进行回顾，以确保一致的诊断，而治疗臂和患者信息对评估者是盲目的。我们将治疗后至少改善一个等级的黏膜破损定义为改善的黏膜，恢复到 M 或 N 级定义为黏膜愈合。
VPZ 和 PPI 组改善黏膜的患者比例分别为 81.3%和 14.3%（p<0.001）。黏膜愈合率分别为 68.8%和 7.1%（p=0.001）。
VPZ 显著改善胃食管反流手术后 PPI 抵抗性 RRE。
