Efficacy of vonoprazan for refractory reflux esophagitis after esophagectomy

Background: Refractory reflux esophagitis (RRE), unresponsive to conventional proton-pump inhibitors (PPIs) is a complication in esophagectomy with gastric pull-up. Vonoprazan, a novel potassium-competitive acid blocker, has been available in Japan since 2015. Here, we investigated the efficacy of vonoprazan 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 (LA) classification and the modified Los Angeles (m-LA) classification to evaluate abnormal forms of mucosal breaks such as spreading laterally consistently. Patien ts 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 vonoprazan (20 mg/day) and 14 patients who continued PPIs were assigned to the v onoprazan and PPI groups, respectively. Endoscopic observations were reviewed by three endoscopists using the r-LA classification to ensure consistent diagnosis, while treatment arm and patient information were blinded to evaluators. We defined mucosal breaks that improved by at least one grade afte r treatment as improved mucosa and recovery to grade M or N as mucosal healing. Results: The percentage of patients with improved mucosa in the vonoprazan and PPI groups was 81.3% and 14.3%, respectively (p
Source: Digestive Diseases - Category: Gastroenterology Source Type: research