, Volume 16, Issue 2, pp 201–206 | Cite as

Efficacy of on-demand therapy using 20-mg vonoprazan for non-erosive reflux disease

  • Yoshimasa Hoshikawa
  • Noriyuki Kawami
  • Shintaro Hoshino
  • Tomohide Tanabe
  • Mariko Umezawa
  • Mitsuru Kaise
  • Katsuhiko IwakiriEmail author
Original Article



To evaluate the efficacy of on-demand therapy using 20-mg vonoprazan for non-erosive reflux disease.


On-demand therapy by taking one 20-mg tablet of vonoprazan only when reflux symptoms occurred was performed for 8 weeks by 30 patients (11 men, mean age: 67.8) with non-erosive reflux disease who responded well to maintenance therapy using proton pump inhibitor and answered “very satisfied” or “satisfied” to an overall satisfaction survey (5-grade scale). The degree of overall satisfaction with the treatment, score of symptoms, and fasting gastrin levels before breakfast was examined before and after on-demand therapy. The number of vonoprazan tablets taken and the frequency (regular, temporary, rare) of its administration were also investigated.


All patients completed 8-week on-demand therapy with 20-mg vonoprazan. Comparisons of patient satisfaction levels before and after therapy revealed no significant differences in the number of patients who were very satisfied and satisfied with the therapy. Furthermore, there were no significant differences in score of symptoms or gastrin levels before and after therapy. During 8-week on-demand therapy, patients took 11 tablets (median) (7.0–18.0 tablets: 25–75 percentiles), and 30.0% of patients (n = 9) took vonoprazan on a regular basis (at least 2 tablets a week).


On-demand therapy with 20-mg vonoprazan exerted equivalent effects to continuous PPI maintenance therapy for patients with non-erosive reflux disease.


Non-erosive reflux disease Vonoprazan On-demand therapy Maintenance therapy 



The authors thank Ms. Satoko Nishimura for administrative assistance.

Compliance with ethical standards

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interest

Katsuhiko Iwakiri has received lecture fees from Takeda Pharmaceutical Co., Ltd. and Otsuka Pharmaceutical Co., Ltd.. The remaining authors declare that they have no conflicts of interest.


  1. 1.
    Joh T, Miwa H, Higuchi K, et al. Validity of endoscopic classification of nonerosive reflux disease. J Gastroenterol. 2007;42:444–9.CrossRefGoogle Scholar
  2. 2.
    Wada T, Sasaki M, Kataoka H, et al. Efficacy of famotidine and omeprazole in healing symptoms of non-erosive gastro-oesophageal reflux disease: randomized-controlled study of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2005;21(Suppl 2):2–9.CrossRefGoogle Scholar
  3. 3.
    Iwakiri K, Kinoshita Y, Habu Y, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol. 2016;51:751–67.CrossRefGoogle Scholar
  4. 4.
    Miwa H, Sasaki M, Furuta T, et al. Efficacy of rabeprazole on heartburn symptom resolution in patients with non-erosive and erosive gastro-oesophageal reflux disease: a multicenter study from Japan. Aliment Pharmacol Ther. 2007;26:69–77.CrossRefGoogle Scholar
  5. 5.
    Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol. 2007;41:131–7.CrossRefGoogle Scholar
  6. 6.
    Kawami N, Takenouchi N, Umezawa M, et al. Pathogenesis of double-dose proton pump inhibitor-resistant non-erosive reflux disease, and mechanism of reflux symptoms and gastric acid secretion-suppressive effect in the presence or absence of Helicobacter pylori infection. Digestion. 2017;95:140–5.CrossRefGoogle Scholar
  7. 7.
    Bell NJ, Hunt RH. Time to maximum effect of lansoprazole on gastric pH in normal male volunteers. Aliment Pharmacol Ther. 1996;10:897–904.CrossRefGoogle Scholar
  8. 8.
    Norris V, Baisley K, Dunn K, et al. Combined analysis of three crossover clinical pharmacology studies of effects of rabeprazole and esomeprazole on 24-h intragastric pH in healthy volunteers. Aliment Pharmacol Ther. 2007;25:501–10.CrossRefGoogle Scholar
  9. 9.
    Sakurai Y, Mori Y, Okamoto H, et al. Acid-inhibitory effects of vonoprazan 20 mg compared with esomeprazole 20 mg or rabeprazole 10 mg in healthy adult male subjects—a randomised open-label cross-over study. Aliment Pharmacol Ther. 2015;42:719–30.CrossRefGoogle Scholar
  10. 10.
    Hoshino S, Kawami N, Takenouchi N, et al. Efficacy of vonoprazan for proton pump inhibitor-resistant reflux esophagitis. Digestion. 2017;95:156–61.CrossRefGoogle Scholar
  11. 11.
    Yamashita H, Kanamori A, Kano C, et al. The effects of switching to vonoprazan, a novel potassium-competitive acid blocker, on gastric acidity and reflux patterns in patients with erosive esophagitis refractory to proton pump inhibitors. Digestion. 2017;96:52–9.CrossRefGoogle Scholar
  12. 12.
    Okuyama M, Nakahara K, Iwakura N, et al. Factors associated with potassium-competitive acid blocker non-response in patients with proton pump inhibitor-refractory gastroesophageal reflux disease. Digestion. 2017;95:281–7.CrossRefGoogle Scholar
  13. 13.
    Umezawa M, Kawami N, Hoshino S, et al. Efficacy of on-demand therapy using 20-mg vonoprazan for mild reflux esophagitis. Digestion. 2018;97:309–15.CrossRefGoogle Scholar
  14. 14.
    Hoshihara Y. Endoscopic findings of GERD. Nihon Rinsho. 2004;62:1459–64.Google Scholar
  15. 15.
    Iwakiri K. Treatment strategy for standard dose proton pump inhibitor-resistant reflux esophagitis. J Nippon Med Sch. 2017;84:209–14.CrossRefGoogle Scholar
  16. 16.
    Iwakiri K, Hoshino S, Kawami N. Mechanisms underlying excessive esophageal acid exposure in patients with gastroesophageal reflux disease. Esophagus. 2017;14:221–8.CrossRefGoogle Scholar
  17. 17.
    Sano H, Iwakiri K, Kawami N, et al. Mechanisms of acid reflux and how refluxed acid extends proximally in patients with non-erosive reflux disease. Digestion. 2014;90:108–15.CrossRefGoogle Scholar
  18. 18.
    Iwakiri K, Hayashi Y, Kotoyori M, et al. Defective triggering of secondary peristalsis in patients with non-erosive reflux disease. J Gastroenterol Hepatol. 2007;22:2208–11.CrossRefGoogle Scholar
  19. 19.
    Jenkins H, Sakurai Y, Nishimura A, et al. Randomised clinical trial: safety, tolerability, pharmacokinetics and pharmacodynamics of repeated doses of TAK-438 (vonoprazan), a novel potassium-competitive acid blocker, in healthy male subjects. Aliment Pharmacol Ther. 2015;41:636–48.CrossRefGoogle Scholar
  20. 20.
    Bayerdörffer E, Bigard MA, Weiss W, et al. Randomized, multicenter study: on-demand versus continuous maintenance treatment with esomeprazole in patients with nonerosive gastroesophageal reflux disease. BMC Gastroenterol. 2016;16:48.CrossRefGoogle Scholar
  21. 21.
    Talley NJ, Lauritsen K, Tunturi-Hihnala H, et al. Esomeprazole 20 mg maintains symptom control in endoscopy-negative gastro-oesophageal reflux disease: a controlled trial of ‘on-demand’ therapy for 6 months. Aliment Pharmacol Ther. 2001;15:347–54.CrossRefGoogle Scholar
  22. 22.
    Nagahara A, Hojo M, Asaoka D, et al. A randomized prospective study comparing the efficacy of on-demand therapy versus continuous therapy for 6 months for long-term maintenance with omeprazole 20 mg in patients with gastroesophageal reflux disease in Japan. Scand J Gastroenterol. 2014;49:409–17.CrossRefGoogle Scholar
  23. 23.
    Ashida K, Sakurai Y, Hori T, et al. Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther. 2016;43:240–51.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society and Springer 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyNippon Medical School, Graduate School of MedicineTokyoJapan

Personalised recommendations