Differences Between Patients with Heartburn Refractory to Vonoprazan and Those Refractory to Proton Pump Inhibitors.
GERD
Heartburn
PPI-refractory
Proton pump inhibitor
Vonoprazan
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
15 Apr 2024
15 Apr 2024
Historique:
received:
04
02
2024
accepted:
26
03
2024
medline:
16
4
2024
pubmed:
16
4
2024
entrez:
15
4
2024
Statut:
aheadofprint
Résumé
Vonoprazan, a potassium-competitive acid blocker, demonstrates more potent acid inhibition than proton pump inhibitors (PPIs). This study aimed to evaluate the effect of vonoprazan in patients with unproven gastroesophageal reflux disease (GERD) by comparing patients with vonoprazan-refractory heartburn with those with PPI-refractory heartburn. This study included 104 consecutive patients with vonoprazan- or PPI-refractory heartburn (52 patients each), no erosive esophagitis on endoscopy and who underwent combined multichannel intraluminal impedance-pH (MII-pH) testing with vonoprazan/PPI discontinuation. Patients' backgrounds, symptom scores from four questionnaires, MII-pH results and high-resolution manometry results were compared between the two groups. The vonoprazan group demonstrated significantly higher GERD symptoms and scores of abdominal pain and diarrhea on the Gastrointestinal Symptom Rating Scale questionnaire. MII-pH results revealed that the vonoprazan group demonstrated 40.4%, 17.3%, and 42.3% and the PPIs group exhibited 26.9%, 17.3%, and 55.8% of abnormal acid reflux [true non-erosive reflux disease (NERD)], reflux hypersensitivity and functional heartburn, respectively. The vonoprazan group demonstrated higher true NERD rates but with no significant difference (p = 0.307). Among the vonoprazan group, eight patients with true NERD underwent another MII-pH test on vonoprazan, and all cases demonstrated normal acid exposure times (0.0% [0.0-0.3]). Patients with unproven GERD with vonoprazan-refractory heartburn demonstrated more symptoms, including not only GERD symptoms but also functional dyspepsia and irritable bowel syndrome symptoms, than those with PPI-refractory heartburn.
Sections du résumé
BACKGROUND
BACKGROUND
Vonoprazan, a potassium-competitive acid blocker, demonstrates more potent acid inhibition than proton pump inhibitors (PPIs). This study aimed to evaluate the effect of vonoprazan in patients with unproven gastroesophageal reflux disease (GERD) by comparing patients with vonoprazan-refractory heartburn with those with PPI-refractory heartburn.
METHODS
METHODS
This study included 104 consecutive patients with vonoprazan- or PPI-refractory heartburn (52 patients each), no erosive esophagitis on endoscopy and who underwent combined multichannel intraluminal impedance-pH (MII-pH) testing with vonoprazan/PPI discontinuation. Patients' backgrounds, symptom scores from four questionnaires, MII-pH results and high-resolution manometry results were compared between the two groups.
RESULTS
RESULTS
The vonoprazan group demonstrated significantly higher GERD symptoms and scores of abdominal pain and diarrhea on the Gastrointestinal Symptom Rating Scale questionnaire. MII-pH results revealed that the vonoprazan group demonstrated 40.4%, 17.3%, and 42.3% and the PPIs group exhibited 26.9%, 17.3%, and 55.8% of abnormal acid reflux [true non-erosive reflux disease (NERD)], reflux hypersensitivity and functional heartburn, respectively. The vonoprazan group demonstrated higher true NERD rates but with no significant difference (p = 0.307). Among the vonoprazan group, eight patients with true NERD underwent another MII-pH test on vonoprazan, and all cases demonstrated normal acid exposure times (0.0% [0.0-0.3]).
CONCLUSION
CONCLUSIONS
Patients with unproven GERD with vonoprazan-refractory heartburn demonstrated more symptoms, including not only GERD symptoms but also functional dyspepsia and irritable bowel syndrome symptoms, than those with PPI-refractory heartburn.
Identifiants
pubmed: 38622462
doi: 10.1007/s10620-024-08411-y
pii: 10.1007/s10620-024-08411-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900–1920.
doi: 10.1111/j.1572-0241.2006.00630.x
pubmed: 16928254
El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63: 871–880.
doi: 10.1136/gutjnl-2012-304269
pubmed: 23853213
Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease. Gastroenterology 2008; 135: 1383–1391.
doi: 10.1053/j.gastro.2008.08.045
pubmed: 18789939
Maret-Ouda J, Markar SR, Lagergren J. Gastroesophageal reflux disease: a review. JAMA 2020; 324: 2536–2547.
doi: 10.1001/jama.2020.21360
pubmed: 33351048
Fass R, Sifrim D. Management of heartburn not responding to proton pump inhibitors. Gut 2009; 58: 295–309.
doi: 10.1136/gut.2007.145581
pubmed: 19136523
Fass R, Zerbib F, Gyawali CP. AGA clinical practice update on functional heartburn: expert review. Gastroenterology 2020; 158: 2286–2293.
doi: 10.1053/j.gastro.2020.01.034
pubmed: 32017911
Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F. Functional esophageal disorders. Gastroenterology 2016; 150: 1368–1379.
doi: 10.1053/j.gastro.2016.02.012
Ashida K, Sakurai Y, Hori T, et al. Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther 2016; 43: 240–251.
doi: 10.1111/apt.13461
pubmed: 26559637
Xiao Y, Zhang S, Dai N, et al. Phase III, randomised, double-blind, multicentre study to evaluate the efficacy and safety of vonoprazan compared with lansoprazole in Asian patients with erosive oesophagitis. Gut 2020; 69: 224–230.
doi: 10.1136/gutjnl-2019-318365
pubmed: 31409606
Laine L, DeVault K, Katz P, et al. Vonoprazan versus lansoprazole for healing and maintenance of healing of erosive esophagitis: a randomized trial. Gastroenterology 2023; 164: 61–71.
doi: 10.1053/j.gastro.2022.09.041
pubmed: 36228734
Akiyama J, Hosaka H, Kuribayashi S et al. Efficacy of vonoprazan, a novel potassium-competitive acid blocker, in patients with proton pump inhibitor-refractory acid reflux. Digestion 2020; 101: 174–183.
doi: 10.1159/000497775
pubmed: 30897577
Okuyama M, Nakahara K, Iwakura N, et al. Factors associated with potassium-competitive acid blocker non-response in patients with proton pump inhibitor-refractory gastroesophageal reflux disease. Digestion 2017; 95: 281–287.
doi: 10.1159/000475658
pubmed: 28501868
Masaoka T, Kameyama H, Yamane T, et al. Pathophysiology of potassium-competitive acid blocker-refractory gastroesophageal reflux and the potential of potassium-competitive acid blocker test. J Neurogastroenterol Motil 2018; 24: 577–583.
doi: 10.5056/jnm18036
pubmed: 30347936
pmcid: 6175552
Hamada S, Ihara E, Ikeda H, et al. Clinical characterization of vonoprazan-refractory gastroesophageal reflux disease. Digestion 2021; 102: 197–204.
doi: 10.1159/000503340
pubmed: 31578027
Hoshikawa Y, Hoshino S, Kawami N, Iwakiri K. Prevalence of behavioral disorders in patients with vonoprazan-refractory reflux symptoms. J Gastroenterol 2021; 56: 117–124.
doi: 10.1007/s00535-020-01751-2
pubmed: 33247348
von Elm E, Altman DG, Egger M, Ocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457.
doi: 10.1016/S0140-6736(07)61602-X
Kusano M, Shimoyama Y, Sugimoto S, et al. Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol 2004; 39: 888–891.
doi: 10.1007/s00535-004-1417-7
pubmed: 15565409
Jones R, Junghard O, Dent J, et al. Development of the GERDQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 2009; 30: 1030–1038.
doi: 10.1111/j.1365-2036.2009.04142.x
pubmed: 19737151
Svedlund J, Sjödin I, Dotevall G. GSRS—a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988; 33: 129–134.
doi: 10.1007/BF01535722
pubmed: 3123181
Turner-Bowker DM, Bayliss MS, Ware JE Jr, Kosinski M. Usefulness of the SF-8 health survey for comparing the impact of migraine and other conditions. Qual Life Res 2003; 12: 1003–1012.
doi: 10.1023/A:1026179517081
pubmed: 14651418
Frazzoni L, Frazzoni M, De Bortoli N, et al. Application of Lyon Consensus criteria for GORD diagnosis: evaluation of conventional and new impedance–pH parameters. Gut 2022; 71: 1062–1067.
doi: 10.1136/gutjnl-2021-325531
pubmed: 34376517
Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut 2023; 73: 361–371 (Online ahead of print).
doi: 10.1136/gutjnl-2023-330616
Frazzoni M, Manta R, Mirante VG, Conigliaro R, Frazzoni L, Melotti G. Esophageal chemical clearance is impaired in gastro-esophageal reflux disease—a 24-h impedance–pH monitoring assessment. Neurogastroenterol Motil 2013; 25: 399–406.
doi: 10.1111/nmo.12080
pubmed: 23360178
Gyawali CP, Rogers B, Frazzoni M, Savarino E, Roman S, Sifrim D. Inter-reviewer variability in interpretation of pH–Impedance Studies: the Wingate Consensus. Clin Gastroenterol Hepatol 2021; 19: 1976–1978.
doi: 10.1016/j.cgh.2020.09.002
pubmed: 32890752
Zhong C, Duan L, Wang K, et al. Esophageal intraluminal baseline impedance is associated with severity of acid reflux and epithelial structural abnormalities in patients with gastroesophageal reflux disease. J Gastroenterol 2013; 48: 601–610.
doi: 10.1007/s00535-012-0689-6
pubmed: 23076541
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45: 172–180.
doi: 10.1136/gut.45.2.172
pubmed: 10403727
pmcid: 1727604
Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006; 131: 1392–1399.
doi: 10.1053/j.gastro.2006.08.032
pubmed: 17101315
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil. 2021; 33: e14058.
doi: 10.1111/nmo.14058
pubmed: 33373111
pmcid: 8034247
Kaji M, Fujiwara Y, Shiba M, et al. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol 2010; 25: 1151–1156.
doi: 10.1111/j.1440-1746.2010.06249.x
pubmed: 20594232