Search

Objective: Artificial ulcers after endoscopic submucosal dissection (ESD) are usually treated by proton pump inhibitors (PPIs) in clinical setting. Vonoprazan, a newly developed potassium-competitive acid blocker, has recently been used to treat post-ESD ulcers. We aimed to evaluate the efficacy and safety of vonoprazan on the healing of post-ESD artificial ulcers compared with those of proton pump inhibitors (PPIs) using a meta-analysis., Methods: EMBASE, MEDLINE, Scopus and Cochrane Library databases were searched for all studies comparing the efficacy and safety of vonoprazan with those of PPIs in the treatment of post-ESD ulcers., Results: Fourteen articles with 1328 patients were included in this meta-analysis. When comparing ulcer shrinkage rate, vonoprazan showed a better efficacy than PPIs (mean difference 0.56, 95% confidence interval [CI] 0.18-0.93). Vonoprazan also led to a higher scar formation rate (odds ratio [OR] 1.58, 95% CI 1.00-2.47) and showed a potential superiority on reducing the risk of post-ESD bleeding compared with PPIs, with a pooled OR of 0.69, although there was no statistically significant difference., Conclusions: Compared with PPIs, vonoprazan showed a better efficacy in ulcer shrinkage rate and achieved more complete healing in the treatment of post-ESD ulcers. Vonoprazan did not induce any incremental risk of post-ESD bleeding as well. It may be an appropriate choice in the management of artificial ulcers after ESD., (© 2019 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Objective: This study aimed to evaluate the efficacy and safety of vonoprazan (VPZ) versus proton pump inhibitor (PPI) in clarithromycin‐based bismuth‐containing quadruple therapy (C‐BQT) for the treatment of Helicobacter pylori (H. pylori) eradication. Methods: Medical records of patients in whom H. pylori was eradicated between 1 July 2018 and 31 December 2021 were retrieved retrospectively from the Outpatient Unit of Qilu Hospital. Efficacy, safety, and compliance were compared between VPZ‐based and PPI‐based C‐BQT, containing vonoprazan 20 mg or proton pump inhibitors (lansoprazole 30 mg or esomeprazole 20 mg), bismuth 220 or 200 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, twice daily for 2 weeks by 1:1 propensity score matching analysis. The trial was registed on ClinicalTrials.gov (registration no. NCT05301725). Results: The H. pylori eradication rates of VPZ‐based and PPI‐based therapies were 88.8% (151/170) and 87.6% (149/170) in the intention‐to‐treat analysis, 94.1% (144/153) and 91.1% (144/158) in the per‐protocol analysis, respectively. The noninferiority of VPZ to PPI was confirmed in all analyses (P < 0.001). The incidence of adverse events was 30.0% (51/170) and 27.1% (46/170) in the VPZ‐based and PPI‐based groups, respectively. VPZ‐based and PPI‐based therapies were well tolerated and showed good patient compliance without significant differences. Conclusions: VPZ‐based therapy resulted in a satisfactory eradication rate and was well tolerated for H. pylori eradication, which are comparable to PPIs in C‐BQT as a first‐line treatment for H. pylori infection. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 63-year-old man who was referred to the Department of Gastroenterology, Qilu Hospital, Shandong University for nausea, vomiting and early satiety over four-months. Topics discussed include treatment failure despite undergoing gastric prokinetics, proton pump inhibitors, antiemetics and dietary manipulation; revealing gastroesophageal anastomosis in gastroscopy; and diagnosis of pylorospasm and undergoing mucosal incision.