Prevalence of behavioral disorders in patients with vonoprazan-refractory reflux symptoms
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ORIGINAL ARTICLE—ALIMENTARY TRACT
Prevalence of behavioral disorders in patients with vonoprazanrefractory reflux symptoms Yoshimasa Hoshikawa1 • Shintaro Hoshino1 • Noriyuki Kawami1 • Katsuhiko Iwakiri1
Received: 21 July 2020 / Accepted: 12 November 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background Behavioral disorders, such as supragastric belching (SGB) and rumination syndrome (RS), which may be treated by cognitive behavioral therapy, are common in patients with reflux symptoms refractory to proton pump inhibitors (PPI). Vonoprazan (VPZ) has been used as a new type of acid inhibitor in Japan since 2015. We herein investigated the prevalence of behavioral disorders in patients with VPZ-refractory reflux symptoms and attempted to identify predictive factors. Methods We retrospectively analyzed esophagogastroduodenograms, high-resolution manometry, and 24-h multiluminal impedance pH-metry (MIIpH) in patients with VPZ-refractory reflux symptoms (heartburn or regurgitation) receiving 20 mg VPZ who underwent these tests at our hospital between January 2015 and April 2020. Patients were divided as follows: non-erosive reflux disease with pathological esophageal acid exposure (NERD), functional heartburn (FH), reflux hypersensitivity (RH), excessive ([ 13 per day) SGB, and possible RS based on MIIpH parameters. Results Among 49 patients, 6 (12.2%) had SGB, 4 (8.2%) possible RS, 29 (59.2%) FH, 9 (18.4%) RH, and 1 (2%) NERD. Possible RS patients had more postprandial nonacid reflux events than FH patients (p \ 0.05). The multivariate logistic regression analysis did not identify any predictive factors with statistical significance.
& Katsuhiko Iwakiri [email protected] 1
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
Conclusion More than 20% patients with VPZ-refractory reflux symptoms had behavioral disorders. The use of HRM and MIIpH may be clinically relevant for a better diagnosis and more specific treatment. Keywords Gastroesophageal reflux disease Behavioral disorders Supragastric belching Rumination syndrome Vonoprazan
Introduction The global prevalence of gastroesophageal reflux disease (GERD) is 8–33% [1]. Empiric proton pump inhibitor (PPI) treatments are not effective in more than 30% of patients with reflux symptoms [2,3]. Previous studies reported that more than 50% of patients with PPI-refractory reflux symptoms had physiological acid exposure with a diagnosis of functional or hypersensitive disorders, such as reflux hypersensitivity (RH) and functional heartburn (FH) [4–6]. However, there are currently no effective standardized treatments for RH or FH [7]. Therefore, a significant number of GERD patients have persistent reflux symptoms despite long-term treatment. PPI refractoriness may be partially associated with behavioral disorders. A recent study on PPI-refractory GERD patients in the US reported that 42% had supragastric belching (SGB) and 24% had rumination syndrome (RS) [8]. More th
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