Differences Between Patients with Heartburn Refractory to Vonoprazan and Those Refractory to Proton Pump Inhibitors

Tomoaki Matsumura; Michiko Sonoda; Kenichiro Okimoto; Hang Viet Dao; Satsuki Takahashi; Naoki Akizue; Ryosuke Horio; Chihiro Goto; Akane Kurosugi; Tatsuya Kaneko; Yuki Ohta; Takashi Taida; Atsuko Kikuchi; Mai Fujie; Jun Kato; Naoya Kato

doi:10.1007/s10620-024-08411-y

Differences Between Patients with Heartburn Refractory to Vonoprazan and Those Refractory to Proton Pump Inhibitors

Dig Dis Sci. 2024 Apr 15. doi: 10.1007/s10620-024-08411-y. Online ahead of print.

Authors

Tomoaki Matsumura¹, Michiko Sonoda², Kenichiro Okimoto², Hang Viet Dao^{2

3

4}, Satsuki Takahashi², Naoki Akizue², Ryosuke Horio², Chihiro Goto², Akane Kurosugi², Tatsuya Kaneko², Yuki Ohta², Takashi Taida², Atsuko Kikuchi⁵, Mai Fujie⁵, Jun Kato², Naoya Kato²

Affiliations

¹ Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan. matsumura@chiba-u.jp.
² Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan.
³ Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam.
⁴ The Institute of Gastroenterology and Hepatology, Hanoi, Vietnam.
⁵ Department of Clinical Engineering Center, Chiba University Hospital, Chiba, Japan.

PMID: 38622462
DOI: 10.1007/s10620-024-08411-y

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]).

Conclusion: 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.

Keywords: GERD; Heartburn; PPI-refractory; Proton pump inhibitor; Vonoprazan.