Suda Hiroko, Eto Sachi, Sakurai Koichi
Hattori Clinic Kumamoto Japan.
DEN Open. 2024 Dec 21;5(1):e70046. doi: 10.1002/deo2.70046. eCollection 2025 Apr.
Vonoprazan is a novel acid blocker with greater potency than proton pump inhibitors. A Japanese study reported no significant safety concerns over 5 years of Vonoprazan use; however, elevated serum gastrin and increased parietal cell and foveolar hyperplasia were observed, and long-term safety data beyond 5 years are limited. We report a case that used Vonoprazan for 6 years, complicated by significant gastric epithelial changes during treatment and acute duodenal mucosal lesions following its discontinuation. A 76-year-old, treated with proton pump inhibitors for over 10 years, was switched to Vonoprazan due to his worsening symptoms. After its use, hemorrhagic hyperplastic polyps became prominent. Given concerns about Vonoprazan's effect on the gastric epithelium, the medication was changed to high-dose H2 blocker therapy. Two months later, the patient complained of vomiting and black tarry stools. Esophagogastroduodenoscopy revealed a significant reduction of gastric polyps but multiple erosions and ulcers in the duodenum. This case indicates the potent effects of Vonoprazan on the gastric mucosa and the risk of severe rebound acid hypersecretion after its long-term use.
沃克是一种新型抑酸剂，其效力强于质子泵抑制剂。一项日本研究报告称，使用沃克5年未发现重大安全问题；然而，观察到血清胃泌素升高以及壁细胞和小凹上皮增生增加，且5年以上的长期安全数据有限。我们报告一例使用沃克6年的病例，治疗期间出现明显的胃上皮改变，停药后出现急性十二指肠黏膜病变。一名76岁男性，使用质子泵抑制剂超过10年，因症状加重改用沃克。使用后，出血性增生性息肉变得明显。鉴于担心沃克对胃上皮的影响，将药物改为高剂量H2受体阻滞剂治疗。两个月后，患者出现呕吐和黑便。食管胃十二指肠镜检查显示胃息肉明显减少，但十二指肠有多处糜烂和溃疡。该病例表明沃克对胃黏膜有强效作用，长期使用后有严重胃酸分泌反跳性增高的风险。
