Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
Department of Pathology, Toranomon Hospital, Tokyo, Japan.
Clin J Gastroenterol. 2024 Aug;17(4):598-601. doi: 10.1007/s12328-024-01961-8. Epub 2024 Apr 4.
Vonoprazan (VPZ) has been available in Japan since 2015. Endoscopic features of proton-pump inhibitor (PPI)-related gastric mucosal changes, including fundic gland and hyperplastic polyps, have been observed. However, the relationship between gastric polyps and VPZ remains unclear. A 65-year-old man with reflux esophagitis-associated symptoms refractory to PPI was referred to our hospital. VPZ (20 mg) was administered for 3 weeks, which proved effective. Afterward, VPZ dose was reduced to 10 mg; the reflux symptoms worsened, and 20 mg VPZ was restarted. Afterward, esophagogastroduodenoscopy (EGD) revealed a gradually enlarging gastric polyp in the cardia. After 5 years of VPZ administration, the patient developed a reddish polyp (approximately 10 mm) with a whitish substance in the cardia. Based on the clinical course, the polyp was considered to have enlarged because of the long-term VPZ administration. After being informed of the endoscopic findings, the patient decided to discontinue VPZ. One year after VPZ discontinuation, EGD revealed a shrunken polyp (5 mm). Long-term acid suppression causes hypergastrinemia, which may lead to gastric mucosal changes, including gastric polyps. There are few case reports of a decrease in the number and size of gastric polyps after VPZ discontinuation. Hence, some VPZ-induced endoscopic changes may be reversible.
沃诺拉赞（VPZ）自 2015 年起在日本上市。已经观察到质子泵抑制剂（PPI）相关胃黏膜变化的内镜特征，包括胃底腺和增生性息肉。然而，胃息肉与 VPZ 之间的关系尚不清楚。一名 65 岁男性因反流性食管炎相关症状对 PPI 治疗无效而被转至我院。给予 VPZ（20mg）治疗 3 周，疗效确切。随后，VPZ 剂量减至 10mg；反流症状恶化，重新开始使用 20mg VPZ。此后，行食管胃十二指肠镜（EGD）检查显示贲门处逐渐增大的胃息肉。VPZ 治疗 5 年后，患者贲门处出现一个红色息肉（约 10mm），表面附有白色物质。根据临床经过，考虑由于长期服用 VPZ 而导致息肉增大。在得知内镜检查结果后，患者决定停止服用 VPZ。VPZ 停药 1 年后，EGD 显示息肉缩小（5mm）。长期抑酸可导致高胃泌素血症，从而可能导致胃黏膜变化，包括胃息肉。有少数关于 VPZ 停药后胃息肉数量和大小减少的病例报告。因此，VPZ 引起的一些内镜变化可能是可逆的。
