Vonoprazan shows efficacy similar to that of proton pump inhibitors with respect to symptomatic, endoscopic, and histolo
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ORIGINAL ARTICLE
Vonoprazan shows efficacy similar to that of proton pump inhibitors with respect to symptomatic, endoscopic, and histological responses in patients with eosinophilic esophagitis Takuya Kuzumoto1 · Fumio Tanaka1 · Akinari Sawada1 · Yuji Nadatani1 · Koji Otani1 · Shuhei Hosomi1 · Noriko Kamata1 · Koichi Taira1 · Yasuaki Nagami1 · Tetsuya Tanigawa1 · Toshio Watanabe1 · Yasuhiro Fujiwara1 Received: 27 June 2020 / Accepted: 15 September 2020 © The Japan Esophageal Society 2020
Abstract Background Eosinophilic esophagitis (EoE) is a chronic allergic disease with esophageal symptoms and intraepithelial eosinophil infiltration. Effects of potassium-competitive acid blockers (P-CABs) on EoE have not been elucidated. We aimed to examine and compare the effects of P-CABs and PPIs on symptomatic, endoscopic, and histological responses of patients with EoE. Methods We analyzed 118 EoE patients who received PPI or P-CAB therapy with rabeprazole 10 mg (RPZ10, N = 22), rabeprazole 20 mg (RPZ20, N = 34), esomeprazole 20 mg (EPZ20, N = 25), or vonoprazan 20 mg (VPZ20, N = 33). We evaluated symptomatic responses by classifying the patients into three groups: complete relief, partial relief, and no change. Endoscopic responses were evaluated using the endoscopic reference score (EREFS) following PPI or P-CAB therapy. Histological responses were evaluated by determining eosinophil counts in esophageal biopsy samples and classifying the patients into two groups: complete remission [0/1 eosinophil/high-power field (eos/HPF)] and remission ( 4 was significantly higher than that after the administration of esomeprazole 20 mg once daily (95% vs. 68%) [9]. Although a case series of VPZ administered to PPI-resistant EoE has been reported, its effect as an initial treatment for EoE has not been elucidated [9]. Therefore, the aim of this study was to investigate the therapeutic effects of VPZ on symptomatic, endoscopic, and histological responses in patients with EoE compared with those of PPIs.
Materials and methods Patients and study design We retrospectively reviewed 197 adult patients who were diagnosed with esophageal eosinophilia in Osaka City University Hospital or Osaka City University Hospital Advanced Medical Center for Preventive Medicine (MedCity21) from January 2010 to June 2019. Esophageal eosinophilia was defined as a condition of ≥ 15 eosinophils per high-power field (eos/HPF) in at least one esophageal biopsy sample. Inclusion criteria were EoE patients who received initial PPI or P-CAB therapy including rabeprazole, esomeprazole, and vonoprazan for at least 8 weeks. EoE was diagnosed as patients with esophageal eosinophilia presenting with clinical symptoms due to esophageal dysfunction such as dysphagia, heartburn, and chest pain according to the United European Gastrointestinal guideline in 2017 and updated international consensus of the AGREE conference in 2018 [1, 11]. Exclusion criteria were as follows: patients with eosinophilic gastroenteritis (EGE), patients with esophageal eosinophilia from oth
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