Direct Comparison of the Efficacy and Safety of Vonoprazan Versus Proton-Pump Inhibitors for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Cheng, Yuan; Liu, Jiali; Tan, Xiang; Dai, Yi; Xie, Chune; Li, Xiaohong; Lu, Qiongqiong; Kou, Fushun; Jiang, Hui; Li, Junxiang

doi:10.1007/s10620-020-06141-5

Cited by 45 publications

(37 citation statements)

References 30 publications

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“…Substituting PPI for vonoprazan in erosive esophagitis can relieve symptoms quickly and significantly. A meta-analysis proved the superiority of vonoprazan against PPI in GERD management and subgroup analysis noted that vonoprazan significantly has higher efficacy in treating erosive esophagitis [ 49 ], especially in CYP2C19 EM patients with an efficacy rate of 90.0%, compared with 79.3% for PPI [ 50 ]. Vonoprazan is also superior against lansoprazole in treating peptic ulcer, with recurrence rates at 3.3% vs. 5.5%, respectively, as confirmed by endoscopy examination [ 51 ].…”

Section: Clinical Benefits Of Vonoprazanmentioning

confidence: 99%

The Potential Benefits of Vonoprazan as Helicobacter pylori Infection Therapy

2020

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Helicobacter pylori infection is a severe global health problem that is closely associated with acid-related diseases and gastric malignancies. Eradicating H. pylori is strongly recommended for lowering peptic ulcer recurrence and preventing gastric cancer. The current approved H. pylori eradication regimen combines a proton pump inhibitor (PPI) with two antibiotics. Unfortunately, this regimen failed to meet expectations mostly due to antibiotic resistance and insufficient gastric acid suppression. Vonoprazan, a novel potassium-competitive acid blocker, showed promising results as a PPI replacement. Vonoprazan inhibits gastric acid secretion by acting as a reversible competitive inhibitor against potassium ions and forming disulfide bonds with the cysteine molecule of H+/K+-ATPase. Vonoprazan has superior pharmacological characteristics over PPI, such as no requirement for acid activation, stability in acidic conditions, shorter optimum acid suppression period, and resistance to cytochrome P (CYP)2C19 polymorphism. Several comparative randomized controlled trials and meta-analyses revealed the superiority of vonoprazan in eradicating H. pylori, notably the resistant strains. The adverse effect caused by vonoprazan is long-term acid suppression that may induce elevated gastrin serum, hypochlorhydria, and malabsorption. All vonoprazan studies have only been conducted in Japan. Further studies outside Japan are necessary for universally conclusive results.

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Section: Clinical Benefits Of Vonoprazanmentioning

confidence: 99%

The Potential Benefits of Vonoprazan as Helicobacter pylori Infection Therapy

2020

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“…The potassium‐competitive acid blockers (P‐CABs) include vonoprazan and tegoprazan, available in Japan and Korea, which are not degraded by gastric acid and are potent acid inhibitors. However, a meta‐analysis reported vonoprazan was not superior to other PPIs in treating GERD with risk ratios for efficacy of 1.06 (95% CI 0.99–1.13), although in severe oesophagitis the results favoured vonoprazan [70]. A network meta‐analysis evaluated if vonoprazan 10 mg or 20 mg was superior to PPIs for maintenance of GERD, and the higher dose was more efficacious than omeprazole, esomeprazole, lansoprazole and rabeprazole [71].…”

Section: Treatment Options For Refractory Gerd and Functional Heartburnmentioning

confidence: 99%

Optimal management of severe symptomatic gastroesophageal reflux disease

Talley

Irani

2020

J. Intern. Med.

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Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to 40% of patients remain symptomatic despite PPI treatment. Refractory reflux refers to continued symptoms despite an adequate trial of PPI, and management remains challenging. The differential diagnosis is important; other oesophageal (e.g. eosinophilic oesophagitis) and gastroduodenal disorders (e.g. functional dyspepsia) should be ruled out, as this changes management. A combination of clinical assessment, endoscopic evaluation and in selected cases oesophageal function testing can help characterize patients with refractory reflux symptoms into oesophageal phenotypes so appropriate therapy can be more optimally targeted. Medical options then may include adding a H2 receptor antagonist, alginates, baclofen or antidepressant therapy, and there is emerging evidence for bile acid sequestrants and diaphragmatic breathing. The demonstration of a temporal association of symptoms with reflux events on pH‐impedance testing (reflux hypersensitivity) serves to focus the management on modulating oesophageal perception and reducing the reflux burden, or identifies those with no obvious pathophysiologic abnormalities (functional heartburn). Anti‐reflux surgery based on randomized controlled trial evidence has a role in reflux hypersensitivity or continued pathological acid reflux despite PPI in carefully considered, fully worked up cases that have failed medical therapy; approximately two of three cases will respond but there is a small risk of complications. In patients with persistent volume reflux despite medical therapy, given the lack of alternatives, anti‐reflux surgery is a consideration. Promising newer approaches include endoscopic techniques. This review aims to summarize current diagnostic approaches and critically evaluates the evidence for the efficacy of available treatments.

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“…Primary management is usually done by a proton-pump inhibitor like omeprazole [1]. In some patients, a case with GERD signs can control them by using over-the-counter medications [10]. This is safer and less costly than using prescription medications [10].…”

Section: Introductionmentioning

confidence: 99%

“…In some patients, a case with GERD signs can control them by using over-the-counter medications [10]. This is safer and less costly than using prescription medications [10]. Some guidelines suggest managing GERD with an H2 antagonist before using a proton-pump inhibitor because of cost and safety concerns [10].…”

Section: Introductionmentioning

confidence: 99%

“…This is safer and less costly than using prescription medications [10]. Some guidelines suggest managing GERD with an H2 antagonist before using a proton-pump inhibitor because of cost and safety concerns [10]. Diagnosis and treatment guidelines of GERD were published in 1995 and updated in 2005, and lastly reviewed in 2013by the American College of Gastroenterology (ACG).…”

Section: Introductionmentioning

confidence: 99%

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Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease

Hassan¹

2020

IJMBS

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Background: Gastroesophageal reflux is defined as a common physiologic phenomenon encountered intermittently by a large population, especially following a feed. Gastroesophageal reflux disease (GERD) happens if the number of gastric juice that refluxes into the esophagus passes the accepted limit, making symptoms with or without correlated esophageal mucosal injury (i.e., esophagitis). Diagnosis and treatment guidelines of gastroesophageal reflux disease (GERD) were announced in 1995 and updated in 2005 and lastly reviewed in 2013 by the American College of Gastroenterology (ACG). These and other guidelines undergo periodic review. Advances continue to be made in GERD, leading us to review and revise previous guideline statements. Here we aimed to review the different updated guidelines of diagnosis and treatment of Gastroesophageal reflux disease (GERD). A web-based search utilizing the advanced characteristics of different databases like PubMed, Google Scholar, Embase, Scopus, and Cochrane electronic databases was carried out. Keywords: Gastroesophageal reflux disease (GERD), Updates, Guidelines, Diagnosis, and Treatment.

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Direct Comparison of the Efficacy and Safety of Vonoprazan Versus Proton-Pump Inhibitors for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Cited by 45 publications

References 30 publications

The Potential Benefits of Vonoprazan as Helicobacter pylori Infection Therapy

The Potential Benefits of Vonoprazan as Helicobacter pylori Infection Therapy

Optimal management of severe symptomatic gastroesophageal reflux disease

Updated Guidelines for the Diagnosis and Treatment of Gastroesophageal Reflux Disease

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