Vonoprazan-associated Gastric Mucosal Redness: A Report of Four Cases

Abstract

To date, no cases of vonoprazan-associated gastric mucosal redness have been reported, and its endoscopic and pathological features remain largely unclear. We report four cases of vonoprazan-associated gastric mucosal redness. In all cases, esophagogastroduodenoscopy (EGD) demonstrated linear or spotty redness that newly appeared in the greater curvature of the middle gastric body after the initiation of vonoprazan, which disappeared after its discontinuation. A tissue biopsy taken from the gastric mucosa with redness revealed inflammatory cell infiltration, parietal cell protrusions (PCPs), and oxyntic gland dilatation. To our knowledge, this is the first report describing the endoscopic and pathological features of vonoprazan-associated gastric mucosal redness.

Vonoprazan-Associated Gastric Mucosal Redness in Non-<b><i>Helicobacter pylori</i></b>-Infected and <b><i>Helicobacter pylori</i></b>-Eradicated Stomach

“…Second, vonoprazan-associated gastric mucosal redness is associated with various pathological findings. Our study confirmed the presence in our cases not only of inflammatory cell infiltration, PCPs, and oxyntic gland dilatation, in agreement with an earlier report [ 5 ], but also of congestion, focal hemorrhage with congestion beneath the basement membrane, and vacuolar degeneration of parietal cells, as new findings. A tissue biopsy specimen taken from the site from which spotty and linear redness had disappeared revealed improvement in focal hemorrhage, with congestion shown to be present in all 4 patients (100%), inflammatory cell infiltration in 2 patients (50%), and PCPs and oxyntic gland dilatation in 2 patients (50%).…”

“…The endoscopic features of vonoprazan-associated gastric mucosal redness in the earlier report were spotty or linear redness in the greater curvature of the gastric body [ 5 ]. It had not been previously observed, newly appeared at least 2 months after initiation of the drug, and disappeared at least 3 months after discontinuation of the drug.…”

“…Vonoprazan is shown to selectively accumulate in gastric parietal cells in the mucosal layer of the rat stomach [ 3 ], and gastric cracked and cobblestone-like mucosa has been first reported as vonoprazan-associated gastric mucosal change [ 4 ]. Very recently, we reported 4 cases of vonoprazan-associated gastric mucosal redness which was characterized as newly appearing after initiation of the drug and disappearing after its discontinuation [ 5 ]. Vonoprazan-associated gastric mucosal redness has been rarely reported with its endoscopic and pathological features poorly described.…”

Propensity score matching analysis: incidence and risk factors for “stardust” gastric mucosa, a novel gastric finding potentially induced by vonoprazan

“…Gastric mucosal changes that may be specific to vonoprazan were mucosal erythema in only four patients. 18 Recently, we detected small white protrusions in a patient's stomach at endoscopy. This differs from other known endoscopic findings such as xanthoma and white globe appearance.…”

The effect of proton pump inhibitors and vonoprazan on the development of ‘gastric mucosal redness’

“…In 2020, Kubo et al ( 4 ) reported a novel lesion which they termed ‘gastric mucosal redness’ in patients undergoing VPZ therapy in a case series. Gastric mucosal redness was characterized by linear or spotty red areas along the greater curvature of the gastric body.…”