Kae Sugawara1, Shigeto Koizumi1, Yohei Horikawa2, Nobuya Mimori2, Tsuyotoshi Tsuji3, Hajime Ishii3, Shusei Fujimori4, Kengo Onochi5, Hiroyuki Watanabe6, Katsunori Iijima7. 1. Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan. 2. Department of Gastroenterology, Hiraka General Hospital, Yokote, Japan. 3. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 4. Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan. 5. Department of Gastroenterology, Omagari Kosei Medical Center, Daisen, Japan. 6. Department of Gastroenterology, Akita Kousei Medical Center, Akita, Japan. 7. Department of Gastroenterology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan. kiijima@med.akita-u.ac.jp.
Abstract
BACKGROUND: The incidence of peptic ulcers unrelated to H. pylori infection and non-steroidal anti-inflammatory drugs (NSAIDs), termed idiopathic peptic ulcers (IPUs), has increased worldwide. We recently reported that IPUs were refractory to proton pump inhibitor (PPI) treatment. Vonoprazan, which was recently developed in Japan, has shown a more potent acid-inhibitory effect than ordinary PPIs. In the present study, we compared the healing rates among peptic ulcers of different etiologies following treatment with vonoprazan. METHOD: A multicenter observational study was performed at six participating hospitals in Akita Prefecture, Japan. Consecutive patients who had endoscopically confirmed gastro-duodenal ulcers were enrolled between August 2016 and March 2018. For each patient, the Helicobacter pylori infection status and NSAID use, including aspirin, were checked, and 20 mg vonoprazan was administered for 6 weeks for duodenal ulcers and 8 weeks for gastric ulcers. The healing status was checked by endoscopy at the end of vonoprazan treatment. Patients were divided into four subgroups according to the H. pylori status and NSAID usage. RESULTS: The proportion of IPUs was 18.2%. A total of 162 patients completed the study protocol. The healing rate of IPUs was marginally lower than that of simple H. pylori-associated ulcers (81.2% vs. 93.5%, P = 0.05). Similarly, the healing rate of NSAID-related ulcers, irrespective of concomitant H. pylori infection, was significantly lower than that of simple H. pylori-associated ulcers. CONCLUSIONS: Six- or 8-week vonoprazan treatment still seems to be insufficient for healing IPUs. Longer-term vonoprazan or another treatment option may be required to heal potentially refractory peptic ulcers.
BACKGROUND: The incidence of peptic ulcers unrelated to H. pyloriinfection and non-steroidal anti-inflammatory drugs (NSAIDs), termed idiopathic peptic ulcers (IPUs), has increased worldwide. We recently reported that IPUs were refractory to proton pump inhibitor (PPI) treatment. Vonoprazan, which was recently developed in Japan, has shown a more potent acid-inhibitory effect than ordinary PPIs. In the present study, we compared the healing rates among peptic ulcers of different etiologies following treatment with vonoprazan. METHOD: A multicenter observational study was performed at six participating hospitals in Akita Prefecture, Japan. Consecutive patients who had endoscopically confirmed gastro-duodenal ulcers were enrolled between August 2016 and March 2018. For each patient, the Helicobacter pyloriinfection status and NSAID use, including aspirin, were checked, and 20 mg vonoprazan was administered for 6 weeks for duodenal ulcers and 8 weeks for gastric ulcers. The healing status was checked by endoscopy at the end of vonoprazan treatment. Patients were divided into four subgroups according to the H. pylori status and NSAID usage. RESULTS: The proportion of IPUs was 18.2%. A total of 162 patients completed the study protocol. The healing rate of IPUs was marginally lower than that of simple H. pylori-associated ulcers (81.2% vs. 93.5%, P = 0.05). Similarly, the healing rate of NSAID-related ulcers, irrespective of concomitant H. pyloriinfection, was significantly lower than that of simple H. pylori-associated ulcers. CONCLUSIONS: Six- or 8-week vonoprazan treatment still seems to be insufficient for healing IPUs. Longer-term vonoprazan or another treatment option may be required to heal potentially refractory peptic ulcers.
Entities:
Keywords:
H. pylori; Non-steroidal anti-inflammatory drugs; Peptic ulcers; Vonoprazan
Authors: Y Sakurai; Y Mori; H Okamoto; A Nishimura; E Komura; T Araki; M Shiramoto Journal: Aliment Pharmacol Ther Date: 2015-07-21 Impact factor: 8.171
Authors: H Miwa; N Uedo; J Watari; Y Mori; Y Sakurai; Y Takanami; A Nishimura; T Tatsumi; N Sakaki Journal: Aliment Pharmacol Ther Date: 2016-11-27 Impact factor: 8.171
Authors: K Ashida; Y Sakurai; T Hori; K Kudou; A Nishimura; N Hiramatsu; E Umegaki; K Iwakiri Journal: Aliment Pharmacol Ther Date: 2015-11-11 Impact factor: 8.171