Long-term vonoprazan therapy is effective for controlling symptomatic proton pump inhibitor-resistant gastroesophageal reflux disease

Abstract

Vonoprazan, a novel potassium-competitive acid blocker, results in greater inhibition of gastric acid secretion than proton pump inhibitors (PPI). The aim of this study was to assess the long-term outcomes of patients with PPI-resistant gastroesophageal reflux disease (GERD) treated with vonoprazan. The medical records of patients with symptomatic GERD treated with vonoprazan for 1 year were retrospectively reviewed. Changes in abdominal symptoms were assessed using the Izumo scale, a self-reported questionnaire which is useful in evaluating the symptoms of GERD, epigastric pain, postprandial distress, constipation and diarrhea, and is commonly used in routine clinical practice. A total of 30 patients were included and stratified into a non-erosive (n=22) and erosive group (n=8). At baseline, postprandial distress symptoms were significantly greater in the non-erosive group compared with the erosive group (P=0.013). Even with vonoprazan therapy, symptoms of GERD in the non-erosive group were refractory compared with the erosive group, and required additional treatment in a larger proportion of patients (45 vs. 13%). GERD symptoms in the non-erosive group significantly improved from baseline and remained better after 1 year of vonoprazan therapy, similar to the erosive group. In addition, vonoprazan improved epigastric pain and postprandial distress symptoms in the non-erosive group, and 1 year of vonoprazan therapy did not aggravate constipation or diarrhea. In conclusion, 1 year of vonoprazan therapy improves GERD symptoms in patients with PPI-resistant GERD.

Keywords: GERD; PPI; dyspepsia; potassium-competitive acid blocker; therapeutic outcome.

Figure 1

Changes in GERD symptoms during the 1 year of vonoprazan therapy in the non-erosive (n=22) and erosive groups (n=8). The scores significantly decrease over the study period (P<0.001 in both groups). ^*P<0.05 vs. the respective erosive group in each month. Line, median; bar, interquartile range. GERD, gastroesophageal reflux disease.

Figure 2

Changes in dyspepsia symptoms. (A) Epigastric pain domain; the scores significantly decrease over the study period in both groups (non-erosive group, P=0.001; erosive group, P=0.018). (B) Postprandial distress domain; the scores significantly decrease in the non-erosive group (non-erosive group, P=0.023; erosive group, p=0.908). ^*P<0.05 vs. the respective erosive group in each month. Line, median; bar, interquartile range.

Figure 3

Changes in lower gastrointestinal symptoms. (A) Constipation domain; the scores did not change significantly over the study period (non-erosive group, P=0.689; erosive group, P=0.344). (B) Diarrhea domain; the scores did not change significantly (non-erosive group, P=0.443; erosive group, P=0.451). Line, median; bar, interquartile range.