METHODS: This study included 104 consecutive patients with vonoprazan- or PPI-refractory heartburn (52 patients each), no erosive esophagitis on endoscopy and who underwent combined multichannel intraluminal impedance-pH (MII-pH) testing with vonoprazan/PPI discontinuation. Patients\' backgrounds, symptom scores from four questionnaires, MII-pH results and high-resolution manometry results were compared between the two groups.
RESULTS: The vonoprazan group demonstrated significantly higher GERD symptoms and scores of abdominal pain and diarrhea on the Gastrointestinal Symptom Rating Scale questionnaire. MII-pH results revealed that the vonoprazan group demonstrated 40.4%, 17.3%, and 42.3% and the PPIs group exhibited 26.9%, 17.3%, and 55.8% of abnormal acid reflux [true non-erosive reflux disease (NERD)], reflux hypersensitivity and functional heartburn, respectively. The vonoprazan group demonstrated higher true NERD rates but with no significant difference (p = 0.307). Among the vonoprazan group, eight patients with true NERD underwent another MII-pH test on vonoprazan, and all cases demonstrated normal acid exposure times (0.0% [0.0-0.3]).
CONCLUSIONS: Patients with unproven GERD with vonoprazan-refractory heartburn demonstrated more symptoms, including not only GERD symptoms but also functional dyspepsia and irritable bowel syndrome symptoms, than those with PPI-refractory heartburn.
方法:这项研究包括104例连续的vonoprazan或PPI难治性胃灼热患者(各52例),在内窥镜检查中没有糜烂性食管炎,并且接受了多通道腔内阻抗-pH(MII-pH)联合vonoprazan/PPI停药的联合检测。病人的背景,四份问卷的症状评分,比较两组的MII-pH结果和高分辨率测压结果。
结果:vonoprazan组表现出更高的GERD症状和胃肠道症状评定量表上的腹痛和腹泻评分。MII-pH结果显示,vonoprazan组显示40.4%,17.3%,42.3%,PPI组为26.9%,17.3%,和55.8%的异常酸反流[真正的非糜烂性反流病(NERD)],反流性过敏和功能性胃灼热,分别。vonoprazan组显示出更高的真实NERD率,但没有显着差异(p=0.307)。在vonoprazan集团中,8名真正的NERD患者接受了另一项对vonoprazan的MII-pH测试,所有病例均显示正常的酸暴露时间(0.0%[0.0-0.3])。
结论:未经证实的GERD伴vonoprazan难治性胃灼热的患者表现出更多的症状,不仅包括GERD症状,还包括功能性消化不良和肠易激综合征症状,比那些PPI难治性胃灼热。