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Comparison of the Effects of Vonoprazan and Lansoprazole for Treating Endoscopic Submucosal Dissection-Induced Artificial Ulcers

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Abstract

Background

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.

Aim

This study aimed to assess and compare the effects of vonoprazan and lansoprazole for treating ESD-induced artificial ulcers.

Methods

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.

Results

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).

Conclusions

Vonoprazan is as effective as lansoprazole in treating ESD-induced ulcers.

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References

  1. Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48:225–229.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Takeuchi N, Umegaki E, Takeuchi T, et al. Gastric ulcer healing after treatment of endoscopic submucosal dissection in Japanese: comparison of H2-receptor antagonist and proton pump inhibitor administration. J Clin Biochem Nutr. 2011;49:216–221.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Uedo N, Takeuchi Y, Yamada T, et al. Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol. 2007;102:1610–1616.

    Article  CAS  PubMed  Google Scholar 

  4. Takizawa K, Oda I, Gotoda T, et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection-an analysis of risk factors. Endoscopy. 2008;40:179–183.

    Article  CAS  PubMed  Google Scholar 

  5. Matsukawa J, Hori Y, Nishida H, et al. A comparative study on the modes of action of TAK-438, a novel potassium-competitive acid blocker, and lansoprazole in primary cultured rabbit gastric glands. Biochem Pharmacol. 2011;81:1145–1151.

    Article  CAS  PubMed  Google Scholar 

  6. Hori Y, Matsukawa J, Takeuchi T, et al. A study comparing the antisecretory effect of Tak-438, a novel potassium-competitive acid blocker, with lansoprazole in animals. J Pharmcol Exp Ther. 2011;337:797–804.

    Article  CAS  Google Scholar 

  7. Ashida K, Sakurai Y, Nishimura A, et al. Randomised clinical trial: a dose-ranging study of vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the treatment of erosive oesophagitis. Aliment Pharmacol Ther. 2015;42:685–695.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Suzuki S, Gotoda T, Kusano C, Iwatsuka K, et al. The efficacy and tolerability of a triple therapy containing a potassium-competitive acid blocker compared with a 7-day ppi-based low-dose clarithromycin triple therapy. Am J Gastroenterol. 2016;111:949–956.

    Article  CAS  PubMed  Google Scholar 

  9. Sue S, Kuwashima H, Iwata Y, et al. The superiority of vonoprazan-based first-line triple therapy with clarithromycin: a prospective multi-center cohort study on helicobacter pylori eradication. Intern Med. 2017;56:1277–1285.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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;96:52–59.

    Article  CAS  PubMed  Google Scholar 

  11. Maruoka D, Arai M, Kasamatsu S, et al. Vonoprazan is superior to proton pump inhibitors in healing artificial ulcers of the stomach post-endoscopic submucosal dissection: a propensity score-matching analysis. Dig Endosc. 2017;29:57–64.

    Article  PubMed  Google Scholar 

  12. Takahashi K, Sato Y, Kohisa J, et al. Vonoprazan 20 mg vs lansoprazole 30 mg for endoscopic submucosal dissection-induced gastric ulcers. World J Gastrointest Endosc. 2016;8:716–722.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tsuchiya I, Kato Y, Tanida E, et al. Effect of vonoprazan on the treatment of artificial gastric ulcers after endoscopic submucosal dissection: prospective randomized controlled trial. Dig Endosc. 2017;29:576–583.

    Article  PubMed  Google Scholar 

  14. Japanese Gastric Cancer Society. evidence-based clinical practice guidelines for diagnosis and treatment of carcinoma of stomach. Cited May 2014. URL: http://www.jgca.jp/guideline/fourth/index.html (in Japanese).

  15. Yamamoto H, Kawata H, Sunada K, et al. Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy. 2003;35:690–694.

    Article  CAS  PubMed  Google Scholar 

  16. Oda I, Gotoda T, Hamanaka H, et al. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc. 2005;17:54–58.

    Article  Google Scholar 

  17. 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;41:636–648.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sakurai Y, Mori Y, Okamoto H, et al. Acid-inhibitor effects of vonoprazan 20 mg compared with esomeprazole 20 mg or lansoprazole 10 mg in healthy adult male subjects-a randomized open-label cross-over study. Aliment Pharmacol Ther. 2015;42:719–730.

    Article  CAS  PubMed  Google Scholar 

  19. Kagawa T, Iwamuro M, Ishikawa S, et al. Vonoprazan prevents bleeding from endoscopic submucosal dissection-induced gastric ulcers. Aliment Pharmacol Ther. 2016;44:583–591.

    Article  CAS  PubMed  Google Scholar 

  20. Miwa H, Uedo N, Watari J, et al. Randomised clinical trial: efficacy and safety of vonoprazan vs. lansoprazole in patients with gastric or duodenal ulcers—results from two phase 3, non-inferiority randomised controlled trials. Aliment Pharmacol Ther. 2017;45:240–252.

    Article  CAS  PubMed  Google Scholar 

  21. Tomita T, Kim Y, Yamasaki T, et al. Prospective randomized controlled trial to compare the effects of omeprazole and famotidine in preventing delayed bleeding and promoting ulcer healing after endoscopic submucosal dissection. J Gastroenterol Hepatol. 2012;27:1441–1446.

    Article  CAS  PubMed  Google Scholar 

  22. Hiroyuki O, Kenshi Y, Mitsuhiro F, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc. 2016;28:3–15.

    Article  Google Scholar 

  23. Takeuchi T, Ota K, Harada S, et al. The postoperative bleeding rate and its risk factors in patients on antithrombotic therapy who undergo gastric endoscopic submucosal dissection. BMC Gastroenterol. 2013;13:136.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lim JH, Kim SG, Choi J, et al. Risk factors of delayed ulcer healing after gastric endoscopic submucosal dissection. Surg Endosc. 2015;29:3666–3673.

    Article  PubMed  Google Scholar 

  25. Battaglia G, Di Mario F, Piccoli A, et al. Clinical markers of slow healing and relapsing gastric ulcer. Gut. 1987;28:210–215.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors would like to show their greatest appreciation to the staff of the Endoscopy Department at Osaka Medical College Hospital and the staff of the Endoscopy Department at First Towakai Hospital.

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Authors and Affiliations

  1. Second Department of Internal Medicine, Osaka Medical Collage, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-0801, Japan

    Ai Hirai, Toshihisa Takeuchi, Yoshiaki Takahashi, Shinpei Kawaguchi, Kazuhiro Ota, Satoshi Harada, Yuichi Kojima & Kazuhide Higuchi

  2. Premier Developmental Research of Medicine, Osaka Medical Collage, Osaka, Japan

    Kazunari Tominaga

  3. Department of Gastroenterology, First Towakai Hospital, Osaka, Japan

    Satoshi Tokioka

Authors
  1. Ai Hirai
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  2. Toshihisa Takeuchi
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  3. Yoshiaki Takahashi
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  4. Shinpei Kawaguchi
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  5. Kazuhiro Ota
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  6. Satoshi Harada
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  7. Yuichi Kojima
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  8. Kazunari Tominaga
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  9. Satoshi Tokioka
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  10. Kazuhide Higuchi
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Corresponding author

Correspondence to Toshihisa Takeuchi.

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Hirai, A., Takeuchi, T., Takahashi, Y. et al. Comparison of the Effects of Vonoprazan and Lansoprazole for Treating Endoscopic Submucosal Dissection-Induced Artificial Ulcers. Dig Dis Sci 63, 974–981 (2018). https://doi.org/10.1007/s10620-018-4948-0

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  • DOI: https://doi.org/10.1007/s10620-018-4948-0

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