PDF(Pubmed)
Abstract：
BACKGROUND: Vonoprazan, a potassium-competitive acid blocker, demonstrates more potent acid inhibition than proton pump inhibitors (PPIs). This study aimed to evaluate the effect of vonoprazan in patients with unproven gastroesophageal reflux disease (GERD) by comparing patients with vonoprazan-refractory heartburn with those with PPI-refractory heartburn.
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.
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.
摘要：
背景：沃诺拉赞，钾竞争性酸阻滞剂，证明比质子泵抑制剂（PPI）更有效的酸抑制。本研究旨在通过比较vonoprazan难治性胃灼热患者和PPI难治性胃灼热患者，评估vonoprazan对未经证实的胃食管反流病（GERD）患者的疗效。
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。
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。
