Clinical Characterization of Vonoprazan-Refractory Gastroesophageal Reflux Disease

Abstract

Introduction: The newly developed vonoprazan (a potassium-competitive acid blocker) has a greater ability to suppress gastric acid production than convention proton pump inhibitors (PPIs). The objective of the present study was to determine how vonoprazan influences the pathogenesis of refractory gastroesophageal reflux disease (GERD) in clinical practice. Methods: Between March 2013 and November 2018, a total of 73 refractory GERD patients (34 in the conventional PPI group versus 39 in the vonoprazan group) were enrolled in this retrospective study. We then compared the underlying disease conditions between the 2 groups, examined by high-resolution manometry and multichannel intraluminal impedance/pH (MII-pH) monitoring. Results: There was a significant difference in the proportion of underlying disease conditions, including erosive esophagitis, non-erosive reflux disease, reflux hypersensitivity, functional heartburn and oesophageal motility disorder (EMD), between the conventional PPI (6, 14, 23, 40 and 17% respectively) and vonoprazan groups (0, 0, 10, 49, and 41% respectively; p < 0.01). No cases of acid-related GERD were observed in the vonoprazan group. When the EMD patients were excluded, the lower oesophageal acid exposure time of the vonoprazan group (0.1% [0.0–0.5%], n = 23) was significantly lower than that of the conventional PPI group (0.35% [0.1–3.9%], n = 28; p < 0.05), and the gastric pH <4 holding time of the vonoprazan group (7.7% [0.7–34.5%]) was also significantly lower than that of the conventional PPI group (61.6% [49.4–74.3%], p < 0.01). Conclusions: Vonoprazan serves as a diagnostic tool to exclude acid-related GERD.

Acid Suppressant Therapy: a Step Forward with Potassium-Competitive Acid Blockers

“…There was a significant difference in the proportion of underlying conditions between the two groups of patients. After excluding esophageal motor disorders, no cases of acid-related GERD (including erosive esophagitis and NERD) were observed in the vonoprazan-resistant GERD group [85]. These findings suggest that vonoprazan could be used as a diagnostic tool to rule out acid-related GERD.…”

“…A recent study [85] evaluated pH impedance and HRM parameters in patients with GERD symptoms resistant to PPI or vonoprazan. There was a significant difference in the proportion of underlying conditions between the two groups of patients.…”

Onigiri esophagography as a screening test for esophageal motility disorders

“…EMDs have a significant impact on society, since they reduce not only quality of life and social labor productivity due to difficulty in swallowing, chest pain and reflux symptoms, 1 , 11 - 13 but can also lead to life-threatening diseases, such as aspiration pneumonia. 14 It has been considerably difficult to detect and diagnose EMDs due to the functional nature of these diseases.…”

Refractory Gastroesophageal Reflux Disease: A Management Update

“…Potassium-competitive acid blockers (PCABs) competitively inhibit proton pumps (hydrogen-potassium ATPases) and have been approved in Japan since 2015 for the treatment of peptic ulcer and reflux esophagitis and eradication of HP infection (127,128). Given their clinical efficacy, experts suggest that they could also be more useful than PPIs as an initial empirical test before performing instrumental diagnostic tests to exclude acidmediated reflux disease (129). Vonoprazan, which is not yet available on the European market, has shown a greater ability in suppressing acid secretion through blocking both inactive and active proton pumps, with a greater duration of action compared to PPIs (130)(131)(132).…”