Efficacy of Vonoprazan, a Novel Potassium-Competitive Acid Blocker, in Patients with Proton Pump Inhibitor-Refractory Acid Reflux

Abstract

<b><i>Background/Aim:</i></b> We evaluated the efficacy of vonoprazan (VPZ), a novel potassium-competitive acid blocker, in patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD), exhibiting continued pathological esophageal acid exposure (EAE). <b><i>Methods:</i></b> Despite ≥8 weeks of appropriate PPI therapy, patients with ­persistent reflux symptoms and pathological EAE times (EAETs ≥4%) were invited to switch to VPZ treatment. After an 8-week-course of once-daily VPZ (20 mg), multichannel intraluminal impedance-pH (MII-pH) monitoring was repeated to compare gastric acid exposure times (GAETs), EAETs, and other reflux parameters relative to the baseline values. Before each MII-pH study, reflux symptom severities were scored using the Gastrointestinal Symptom Rating Scale; erosive esophagitis and fasting plasma gastrin levels were also assessed. <b><i>Results:</i></b> From among the 124 patients undergoing MII-pH monitoring, 13 patients (median age, 69 years; females, 64%) were monitored at baseline (while on PPI therapy) and after VPZ therapy. The median GAET associated with VPZ treatment (23.8%) was less than that for PPI treatment (41.1%; <i>p</i> = 0.01), including both daytime and nighttime measurements. VPZ therapy resulted in better median EAET values (4.5%) than did PPI therapy (10.6%) during the 24-h monitoring period (<i>p</i> = 0.055). EAE normalization was achieved in 46% of VPZ-treated patients and was associated with complete gastric acid suppression (<i>p</i> = 0.005). After switching to VPZ, reflux symptoms (<i>p</i> < 0.01) and erosive esophagitis (<i>p</i> = 0.01) improved. <b><i>Conclusion:</i></b> In patients with PPI-refractory GERD, VPZ provides more potent gastric acid suppression, more effective EAE control, enhanced symptom improvement, and better esophagitis healing than PPIs.

How to Apply FMT More Effectively, Conveniently and Flexible – A Comparison of FMT Methods

“…Enterosolvent capsules can be advantageous due to their ability to transport the faecal matter to the small intestines, thus protecting it from gastric acid. During the FMT procedure, a proton pump inhibitor (PPI) is administered to the patients as premedication, so the gastric juice can exceed pH 5 (Akiyama et al, 2019). This means that the faecal material is protected against gastric acid by PPI; on the other hand, PPI might be contraindicated in the case of enterosolvent capsules.…”

Prevalence of CYP2C19 polymorphism in Bogotá, Colombia: The first report of allele *17

“…However, there is little information about the effect of the CYP2C19 polymorphism when dexlansoprazole is used [11]. Furthermore, indirect evidence of the relevance of gastric acid is that vonoprazan, a more powerful PPI that acts independently of CYP2C19, improves the symptoms of many patients with GERD that is refractory to conventional PPIs [17,40].…”

Pharmacologic treatment of GERD: Where we are now, and where are we going?

“…In addition, significantly more patients attained complete nocturnal heartburn relief with vonoprazan than with lansoprazole 121 . In patients with esophagitis and persistent symptoms after 8 weeks of appropriate PPI therapy, 89,122 switching to vonoprazan (20 mg once‐daily) provides more potent gastric acid suppression, more effective control of esophageal exposure to acid, enhanced symptom improvement, and faster healing of mucosal lesions 123 . While a pairwise meta‐analysis is ongoing, 124 a systematic review with a network meta‐analysis 125 shows that the GERD‐healing effect of vonoprazan is higher than that with rabeprazole (20 mg) but not higher than other PPIs.…”