vonoprazan and Adenoma

Vonoprazan exhibits a more potent, rapid, and longer-lasting inhibitory effect on gastric acid secretion than proton pump inhibitors; however, whether it is more effective than PPI for treating endoscopic submucosal dissection (ESD)-induced artificial ulcers remains controversial.. This study aimed to assess and compare the effects of vonoprazan and lansoprazole for treating ESD-induced artificial ulcers.. This prospective, randomized controlled trial enrolled 149 patients who underwent ESD for the treatment of early gastric neoplasms from April 2015 to May 2017. They were randomly treated with either 20 mg/day vonoprazan (V group) or 30 mg/day lansoprazole (L group) orally. The primary end points were the area and shrinkage ratio of the ulcers at 4 and 8 weeks post-ESD.. Data from 127 patients were analyzed, which showed that the 4- and 8-week healing ratios were not significantly different between the V and L groups (4 weeks, 16.3 vs. 25.8%; 8 weeks, 86.9 vs. 90.9%, respectively). Similarly, the shrinkage ratio, categorized as less than 90%, 90% or more but less than 100%, or 100% at 4 weeks and as less than 100% or 100% at 8 weeks were not statistically different between the V and L groups (4 weeks: 12, 41, 8 vs. 13, 41, 12, p = 0.7246; 8 weeks: 9, 52 vs. 9, 57, p = 0.8568). Delayed bleeding was also not significantly different between both the groups (5.4 vs. 5.3%; p = 0.9844).. Vonoprazan is as effective as lansoprazole in treating ESD-induced ulcers.

Topics: Adenoma; Aged; Aged, 80 and over; Endoscopic Mucosal Resection; Female; Humans; Lansoprazole; Male; Middle Aged; Postoperative Complications; Prospective Studies; Proton Pump Inhibitors; Pyrroles; Stomach Neoplasms; Stomach Ulcer; Sulfonamides

Vonoprazan, a potassium-competitive acid blocker, is expected to improve the healing of endoscopic submucosal dissection (ESD)-induced gastric ulcers compared with proton pump inhibitors (PPIs).. To compare the healing status of ESD-induced gastric ulcers and the incidence of post-ESD bleeding between subjects treated with vonoprazan for 5 weeks and those treated with PPIs for 8 weeks.. Patients in the vonoprazan group (n = 75) were prospectively enrolled, whereas patients in the PPI group (n = 150) were selected for a 2:1 matched historical control cohort according to baseline characteristics including gastric ulcer size immediately following ESD, age, sex and status of Helicobacter pylori infection. Two controls per case of vonoprazan-treated group were matched with a margin of 20% in terms of ulcer size and a margin of 5 years in terms of their age.. Although a higher number of completely healed ulcers was observed in the PPI group (95/150, 63.3%) than that in the vonoprazan group (14/75, 18.7%; P < 0.001), the ulcer size reduction rates, which were 96.0 ± 6.7% in the vonoprazan group and 94.7 ± 11.6% in the PPI group, were not significantly different (P = 0.373). The post-ESD bleeding incidence in the vonoprazan group (1/75, 1.3%) was less than that in the PPI group (15/150, 10.0%; P = 0.01). The factors affecting post-ESD bleeding incidence were the type of acid secretion inhibitor (P = 0.016) and use of an anti-thrombotic agent (P = 0.014).. Vonoprazan significantly reduced post-endoscopic submucosal dissection bleeding compared with PPIs.

Topics: Adenoma; Aged; Aged, 80 and over; Endoscopic Mucosal Resection; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Proton Pump Inhibitors; Pyrroles; Rabeprazole; Stomach Neoplasms; Stomach Ulcer; Sulfonamides; Wound Healing

Topics: Adenoma; Antibodies, Monoclonal, Humanized; Circulating Tumor DNA; Colonoscopy; Colorectal Neoplasms; Congresses as Topic; Decontamination; Drug Therapy, Combination; Duodenoscopy; Eosinophilic Esophagitis; Helicobacter Infections; Helicobacter pylori; Humans; Proton Pump Inhibitors; Pyrroles; Sulfonamides