Okanobu H.a· Kohno T.a· Boda K.a· Ochi H.b· Furukawa Y.a

Author affiliations

aDepartment of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
bDepartment of Medical Checkup Center, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

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Article / Publication Details

First-Page Preview

Received: August 12, 2022
Accepted: December 10, 2022
Published online: January 30, 2023

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 5

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG

Abstract

Introduction: This study aimed to investigate the clinical course of patients with healed mild erosive esophagitis and clarify the predictive factors for continuous treatment. Method: Fifty-one patients with mild erosive esophagitis who confirmed mucosal healing by endoscopy after initial treatment with vonoprazan (VPZ) were enrolled. The patients continued subsequent treatment of their choice: maintenance therapy with VPZ 10 mg (n = 15), on-demand therapy with VPZ 20 mg (n = 19), or no medication (n = 17). Each patient was prospectively followed up for over 2 years, and the treatment was switched to other options appropriately according to their symptoms. Results: During the mean follow-up period of 3.1 years (range: 2.0–3.9 years), 2 patients who chose maintenance therapy switched to on-demand therapy. One patient who chose on-demand therapy switched to maintenance therapy, while 3 patients switched to no medication. Recurrence of symptoms occurred in 9 patients who chose no medication. They were administered maintenance therapy and five of them were subsequently switched to on-demand therapy. Ultimately, the proportion of patients receiving each treatment was 35.3% (18/51) for maintenance therapy, 43.1% (22/51) for on-demand therapy, and 21.6% (11/51) for no medication. A predictive factor for the need for continuous treatment was the presence of esophageal hiatal hernia (odds ratio: 6.03, 95% confidence interval: 1.43–25.3, p = 0.014). Conclusion: Among patients with healed mild erosive esophagitis, 78.4% required continuous treatment with VPZ, while 21.6% remained symptom free with no medication. On-demand therapy was the most common treatment, and continuous treatment may be recommended for patients with esophageal hiatal hernia.

© 2023 S. Karger AG, Basel

References Ashida K, Sakurai Y, Hori T, Kudou K, Nishimura A, Hiramatsu N, et al. Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther. 2016;43(2):240–51. Hoshino S, Kawami N, Takenouchi N, Umezawa M, Hanada Y, Hoshikawa Y, et al. Efficacy of vonoprazan for proton pump inhibitor-resistant reflux esophagitis. Digestion. 2017;95(2):156–61. Oshima T, Arai E, Taki M, Kondo T, Tomita T, Fukui H, et al. Randomised clinical trial: vonoprazan versus lansoprazole for the initial relief of heartburn in patients with erosive oesophagitis. Aliment Pharmacol Ther. 2019;49(2):140–6. Miyazaki H, Igarashi A, Takeuchi T, Teng L, Uda A, Deguchi H, et al. Vonoprazan versus proton-pump inhibitors for healing gastroesophageal reflux disease: a systematic review. J Gastroenterol Hepatol. 2019;34(8):1316–28. Xiao Y, Zhang S, Dai N, Fei G, Goh KL, Chun HJ, et al. Phase III, randomised, double-blind, multicentre study to evaluate the efficacy and safety of vonoprazan compared with lansoprazole in Asian patients with erosive oesophagitis. Gut. 2020;69(2):224–30. Altomare A, Guarino MPL, Cocca S, Emerenziani S, Cicala M. Gastroesophageal reflux disease: update on inflammation and symptom perception. World J Gastroenterol. 2013;19(39):6523–8. Armstrong D. Endoscopic evaluation of gastro-esophageal reflux disease. Yale J Biol Med. 1999;72(2–3):93–100. Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol. 2016;51(8):751–67. Manabe N, Yoshihara M, Sasaki A, Tanaka S, Haruma K, Chayama K. Clinical characteristics and natural history of patients with low-grade reflux esophagitis. J Gastroenterol Hepatol. 2002;17(9):949–54. Manabe N, Haruma K. Optimal acid suppressive treatment for adequate symptom relief and prevention of the complications of gastroesophageal reflux disease: differences in long-term clinical course and pathophysiology among disease subtypes. Esophagus. 2017;14(2):113–21. Labenz J, Nocon M, Lind T, Leodolter A, Jaspersen D, Meyer-Sabellek W, et al. Prospective follow-up data from the ProGERD study suggest that GERD is not a categorial disease. Am J Gastroenterol. 2006;101(11):2457–62. Jung SH, Oh JH, Kang SG. Clinical characteristics and natural history of asymptomatic erosive esophagitis. Turk J Gastroenterol. 2014;25(3):248–52. Okanobu H, Kohno T, Mouri R, Hatsushika Y, Yamashita Y, Miyaki E, et al. Efficacy of vonoprazan 10 mg compared with 20 mg for the initial treatment in patients with erosive esophagitis: a randomized pilot study. Esophagus. 2021;18(3):669–75. Kusano M, Shimoyama Y, Sugimoto S, Kawamura O, Maeda M, Minashi K, et al. Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol. 2004;39(9):888–91. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172–80. Miwa H, Yokoyama T, Hori K, Sakagami T, Oshima T, Tomita T, et al. Interobserver agreement in endoscopic evaluation of reflux esophagitis using a modified Los Angeles classification incorporating grades N and M: a validation study in a cohort of Japanese endoscopists. Dis Esophagus. 2008;21(4):355–63. Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;1(03):87–97. Pace F, Tonini M, Pallotta S, Molteni P, Porro GB. Systematic review: maintenance treatment of gastro-oesophageal reflux disease with proton pump inhibitors taken ‘on-demand’. Aliment Pharmacol Ther. 2007;26(2):195–204. Kovacs TO, Freston JW, Haber MM, Atkinson S, Hunt B, Peura DA. Long-term quality of life improvement in subjects with healed erosive esophagitis: treatment with lansoprazole. Dig Dis Sci. 2010;55(5):1325–36. Fass R, Delemos B, Nazareno L, Kao R, Xiang J, Lu Y. Clinical trial: maintenance intermittent therapy with rabeprazole 20 mg in patients with symptomatic gastro-oesophageal reflux disease - a double-blind, placebo-controlled, randomized study. Aliment Pharmacol Ther. 2010;31(9):950–60. Ashida K, Iwakiri K, Hiramatsu N, Sakurai Y, Hori T, Kudou K, et al. Maintenance for healed erosive esophagitis: phase III comparison of vonoprazan with lansoprazole. World J Gastroenterol. 2018;24(14):1550–61. Miwa H, Igarashi A, Teng L, Uda A, Deguchi H, Tango T. Systematic review with network meta-analysis: indirect comparison of the efficacy of vonoprazan and proton-pump inhibitors for maintenance treatment of gastroesophageal reflux disease. J Gastroenterol. 2019;54(8):718–29. Tanabe T, Hoshino S, Kawami N, Hoshikawa Y, Hanada Y, Takenouchi N, et al. Efficacy of long-term maintenance therapy with 10-mg vonoprazan for proton pump inhibitor-resistant reflux esophagitis. Esophagus. 2019;16(4):377–81. Umezawa M, Kawami N, Hoshino S, Hoshikawa Y, Koizumi E, Takenouchi N, et al. Efficacy of on-demand therapy using 20-mg vonoprazan for mild reflux esophagitis. Digestion. 2018;97(4):309–15. Sakurai Y, Mori Y, Okamoto H, Nishimura A, Komura E, Araki T, et al. Acid-inhibitory effects of vonoprazan 20 mg compared with esomeprazole 20 mg or rabeprazole 10 mg in healthy adult male subjects - a randomised open-label cross-over study. Aliment Pharmacol Ther. 2015;42(6):719–30. Azumi T, Adachi K, Arima N, Tanaka S, Yagi J, Koshino K, et al. Five-year follow-up study of patients with reflux symptoms and reflux esophagitis in annual medical check-up field. Intern Med. 2008;47(8):691–6. Malfertheiner P, Nocon M, Vieth M, Stolte M, Jaspersen D, Koelz HR, et al. Evolution of gastro-oesophageal reflux disease over 5 years under routine medical care - the ProGERD study. Aliment Pharmacol Ther. 2012;35(1):154–64. Ness-Jensen E, Lindam A, Lagergren J, Hveem K. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the HUNT study. Gut. 2012;61(10):1390–7. Shah A, Shibli F, Kitayama Y, Fass R. The natural course of gastroesophageal reflux disease: a critical appraisal of the literature. J Clin Gastroenterol. 2021;55(1):12–20. Nocon M, Labenz J, Jaspersen D, Meyer-Sabellek W, Stolte M, Lind T, et al. Long-term treatment of patients with gastro-oesophageal reflux disease in routine care - results from the ProGERD study. Aliment Pharmacol Ther. 2007;25(6):715–22. Armstrong D. Systematic review: persistence and severity in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2008;28(7):841–53. Article / Publication Details

First-Page Preview

Received: August 12, 2022
Accepted: December 10, 2022
Published online: January 30, 2023

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 5

ISSN: 0012-2823 (Print)
eISSN: 1421-9867 (Online)

For additional information: https://www.karger.com/DIG

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