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Efficacy of Vonoprazan for Refractory Reflux Esophagitis after Esophagectomy
- Source :
- Dig Dis
- Publication Year :
- 2020
-
Abstract
- Background: Refractory reflux esophagitis (RRE), unresponsive to conventional proton-pump inhibitors (PPIs), is a complication in esophagectomy with gastric pull-up. Vonoprazan (VPZ), a novel potassium-competitive acid blocker, has been available in Japan since 2015. Here, we investigated the efficacy of VPZ on PPI-resistant RRE after esophagectomy with gastric pull-up. Methods: This was a single-center retrospective study. We used the revised Los Angeles (r-LA) classification based on the Los Angeles classification and the modified Los Angeles classification to evaluate abnormal forms of mucosal breaks such as lateral spreading consistently. Patients who underwent esophagectomy with gastric pull-up and had RRE grade B–D as per the r-LA classification, despite using standard-dose PPIs or double dose of rabeprazole, were included. Sixteen patients who switched to VPZ (20 mg/day) and 14 patients who continued PPIs were assigned to the VPZ and PPI groups, respectively. Endoscopic observations were reviewed by 3 endoscopists using the r-LA classification to ensure consistent diagnosis, while the treatment arm and patient information were blinded to evaluators. We defined mucosal breaks that improved by at least one grade after treatment as improved mucosa and recovery to grade M or N as mucosal healing. Results: The percentage of patients with improved mucosa in the VPZ and PPI groups was 81.3 and 14.3%, respectively (p < 0.001). The rate of mucosal healing was 68.8 and 7.1%, respectively (p = 0.001). Conclusion: VPZ significantly improved PPI-resistant RRE after esophagectomy with gastric pull-up.
- Subjects :
- medicine.medical_specialty
Vonoprazan
medicine.drug_class
medicine.medical_treatment
Rabeprazole
Proton-pump inhibitor
Gastroenterology
Refractory
Internal medicine
medicine
Humans
Pyrroles
Reflux esophagitis
Esophagus: Research Article
Esophagitis, Peptic
Retrospective Studies
Sulfonamides
business.industry
Retrospective cohort study
Proton Pump Inhibitors
General Medicine
Esophagectomy
Treatment Outcome
Complication
business
medicine.drug
Subjects
Details
- ISSN :
- 14219875
- Volume :
- 39
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Digestive diseases (Basel, Switzerland)
- Accession number :
- edsair.doi.dedup.....402dd7caa19a37f67f1681fe032a1b68