PMID- 32062650
OWN - NLM
STAT- MEDLINE
DCOM- 20210818
LR  - 20210818
IS  - 1421-9867 (Electronic)
IS  - 0012-2823 (Linking)
VI  - 102
IP  - 3
DP  - 2021
TI  - The Ameliorating Effect of Switching to Vonoprazan: A Novel Potassium-Competitive 
      Acid Blocker in Patients with Proton Pump Inhibitor Refractory Non-Erosive Reflux 
      Disease.
PG  - 480-488
LID - 10.1159/000506152 [doi]
AB  - INTRODUCTION: Weakly acidic reflux has been reported to be the major cause of 
      symptoms in patients with proton pump inhibitor (PPI)-refractory nonerosive 
      reflux disease (NERD) undergoing PPI treatment. We previously reported that 
      reflux at pH 4-5 was the main factor that induced symptoms in such patients. The 
      present study aimed to elucidate the symptom-ameliorating effect of vonoprazan 
      (VPZ) by evaluating the change in the pH value of the refluxate using 
      multichannel intraluminal impedance and pH (MII-pH) monitoring. METHODS: We 
      retrospectively evaluated the records of MII-pH monitoring in 29 symptom index 
      (SI) and/or symptom association probability (SAP)-positive patients with 
      PPI-refractory NERD. After switching to VPZ 20 mg/day, we performed MII-pH 
      monitoring again. We assessed the change in the score of the frequency scale for 
      the symptoms of gastroesophageal reflux disease (FSSG), the pH value of the 
      refluxate, and the percent times of intragastric pH <4 or <5 before and after 
      switching. We divided the patients into the following 2 groups according to the 
      FSSG score after switching: effective and noneffective groups. RESULTS: Among of 
      the 29 SI/SAP-positive patients, 16 underwent switching to VPZ. Furthermore, of 
      these 16 patients, 10 underwent MII-pH monitoring again after switching. The FSSG 
      score decreased, the pH value of the refluxate increased, and the percent times 
      of intragastric pH <4 or <5 reduced after switching when compared with the 
      findings before switching. In the effective group, both the proportion of reflux 
      at pH <4 and that of reflux at pH 4-5 decreased while taking VPZ when compared 
      with the findings while taking double-dose PPI. In the noneffective group, the 
      proportion of reflux at pH <4 decreased but that of reflux at pH 4-5 increased 
      and that of reflux at pH <5 did not change overall while taking VPZ. In addition, 
      the percent times of intragastric pH <5 values were low in the effective group. 
      CONCLUSION: Symptom suppression appears to be inadequate in patients with 
      persistent reflux at pH 4-5 even with VPZ 20 mg/day. Strong acid suppressive 
      therapy with VPZ to increase the pH value of the refluxate to >/=5 is useful for 
      symptom improvement.
CI  - (c) 2020 S. Karger AG, Basel.
FAU - Abe, Yasuaki
AU  - Abe Y
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Koike, Tomoyuki
AU  - Koike T
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan, tkoike@rd5.so-net.ne.jp.
FAU - Saito, Masahiro
AU  - Saito M
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Okata, Tomoki
AU  - Okata T
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Nakagawa, Kenichiro
AU  - Nakagawa K
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Hatta, Waku
AU  - Hatta W
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Asanuma, Kiyotaka
AU  - Asanuma K
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Uno, Kaname
AU  - Uno K
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Asano, Naoki
AU  - Asano N
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Imatani, Akira
AU  - Imatani A
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
FAU - Masamune, Atsushi
AU  - Masamune A
AD  - Division of Gastroenterology, Tohoku University Graduate School of Medicine, 
      Sendai, Japan.
LA  - eng
PT  - Journal Article
DEP - 20200214
PL  - Switzerland
TA  - Digestion
JT  - Digestion
JID - 0150472
RN  - 0 
      (1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Pyrroles)
RN  - 0 (Sulfonamides)
RN  - RWP5GA015D (Potassium)
SB  - IM
MH  - Esophageal pH Monitoring
MH  - *Gastroesophageal Reflux/drug therapy
MH  - Humans
MH  - Potassium
MH  - *Proton Pump Inhibitors/therapeutic use
MH  - Pyrroles
MH  - Retrospective Studies
MH  - Sulfonamides
OTO - NOTNLM
OT  - Vonoprazan
OT  - pH value
OT  - Potassium-competitive acid blocker 
OT  - Proton pump inhibitor-refractory nonerosive reflux disease 
EDAT- 2020/02/18 06:00
MHDA- 2021/08/19 06:00
CRDT- 2020/02/17 06:00
PHST- 2019/09/25 00:00 [received]
PHST- 2020/01/24 00:00 [accepted]
PHST- 2020/02/18 06:00 [pubmed]
PHST- 2021/08/19 06:00 [medline]
PHST- 2020/02/17 06:00 [entrez]
AID - 000506152 [pii]
AID - 10.1159/000506152 [doi]
PST - ppublish
SO  - Digestion. 2021;102(3):480-488. doi: 10.1159/000506152. Epub 2020 Feb 14.