The Effects of Switching to Vonoprazan, a Novel Potassium-Competitive Acid Blocker, on Gastric Acidity and Reflux Patterns in Patients with Erosive Esophagitis Refractory to Proton Pump Inhibitors

Background: Gut dysbiosis associated with the use of proton-pump inhibitors (PPIs) has been found to lead to the occurrence of infectious and inflammatory adverse events. A longitudinal observational cohort study has demonstrated the heightened risk of death associated with PPI use. Summary: We evaluated meta-analyses to determine the association between PPI use and infectious and inflammatory diseases. Meta-analyses showed that PPI use is a potential risk for the development of enteric infections caused by Clostridium difficile, as well as small intestinal bacterial overgrowth, spontaneous bacterial peritonitis, community-acquired pneumonia, hepatic encephalopathy, and adverse outcomes in inflammatory bowel disease. We also examined changes in the composition and function of the gut microbiota with the use of PPIs. PPI use significantly increased the presence of Streptococcaceae and Enterococcaceae, which are risk factors for C. difficile infection, and decreased that of Faecalibacterium, a commensal anti-inflammatory microorganism. Key Message: High-throughput, microbial 16S rRNA gene sequencing has allowed us to investigate the association between the gut microbiome and PPI use. Future prospective comparison studies are necessary to confirm this association, and to develop new strategies to prevent complications of PPI use

Section: Dysbiosis Induced By Ppismentioning

confidence: 99%

Intestinal Dysbiosis Secondary to Proton-Pump Inhibitor Use

Naito

Kashiwagi²,

Takagi³

et al. 2018

“…Changes in the gastric pH after a single 20 mg administration of vonoprazan suggest that it is the optimal agent for on-demand therapy for reflux symptoms. Although the efficacy of vonoprazan for PPI-resistant RE has been reported [13, 14, 15], no results of on-demand therapy for mild RE using vonoprazan at 20 mg have been reported. Moreover, the problem of hypergastrinemia caused by long-term use of vonoprazan may be resolved by on-demand therapy.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of On-Demand Therapy Using 20-mg Vonoprazan for Mild Reflux Esophagitis

Umezawa¹,

Kawami²,

Hoshino³

et al. 2018

Background: The study aimed to evaluate the efficacy of on-demand therapy using 20-mg vonoprazan for mild reflux esophagitis (RE). Methods: On-demand therapy by taking one 20-mg tablet of vonoprazan only when reflux symptoms occurred was performed for 24 weeks using 30 patients with mild RE who were receiving maintenance therapy with proton pomp inhibitors (PPIs). The presence or absence of RE, degree of overall satisfaction with the treatment, score of symptoms, and fasting gastrin level before breakfast were examined before and after on-demand therapy. The number of tablets taken during the 24-week period was also noted. Results: One of the 30 patients dropped out of on-demand therapy 1 week after its initiation. Remission was maintained in 25 (86.2%) of the 29 patients (all 10 [100%] Los Angeles classification grade A patients and 15 (78.9%) of the 19 grade B patients). However, 4 grade B patients exhibited grade B relapse. There were no differences in the degree of overall satisfaction, score of symptoms or the gastrin level between PPI and on-demand therapies. The number of vonoprazan tablets taken during the observation period was 33 tablets (median)/24 weeks. Conclusion: On-demand therapy using 20-mg vonoprazan tablets is an effective alternative maintenance therapy for mild RE.

“…In Japan, 3 kinds of PPI – Esomeprazole, Lansoprazole and Rabeprazole – and a new type of PPI (vonoprazan) were adopted to be covered by health insurance [19, 20]. Recent reports indicated the effectiveness of vonoprazan in patients with reflux esophagitis refractory or resistant to PPIs [21-23]. The serum gastrin levels increased after the administration of both vonoprazan and lansoprazole in Japanese patients with erosive esophagitis, and were higher in the vonoprazan group compared to the lansoprazole group [24].…”

Section: Introductionmentioning

confidence: 99%

Hypergastrinemia in Long-Term Use of Proton Pump Inhibitors

Shiotani¹,

Katsumata²,

Gouda³

et al. 2018

Background/Aim: The use of proton pump inhibitors (PPIs) is known to lead to hypergastrinemia; however, the data in patients with atrophic gastritis is still lacking. The aim of this study was to investigate the effects of long-term PPIs use on the gastrin levels in patients with atrophic gastritis and to determine factors affecting hypergastrinemia in long-term users of PPIs. Methods: Serum Helicobacter pylori IgG, gastrin and pepsinogen levels were measured. Atrophic gastritis was assessed by upper gastrointestinal endoscopies based on the Kimura-Takemoto classification and pepsinogen levels. CYP2C19 polymorphisms were assessed using DNA extracted from peripheral blood. Results: A total number of 382 patients (275 men and 107 women) were enrolled. Median serum gastrin levels were higher in PPI users than in non- users (234 vs. 113 pg/mL, p < 0.001) and in women than in men (252 vs. 155 pg/mL, p = 0.006). Gastrin levels were significantly associated with corpus atrophy only in the subgroup of non-users of PPIs. Multivariate analysis revealed that hypergastrinemia (over 150 pg/mL) was significantly associated with PPI use (OR 5.30; 95% CI 3.32–8.47), women (OR 2.22; 95% CI 1.33–3.72) and corpus atrophy (OR 1.82; 95% CI 1.14–2.90). Conclusion: PPI use, women and corpus atrophy were risk factors for hypergastrinemia. Gender, but not corpus atrophy, affected the gastrin levels in long-term users of PPIs.