A Prospective Randomized Trial of a Potassium Competitive Acid Blocker Vs Proton Pump Inhibitors on the Effect of Ulcer Healing After Endoscopic Submucosal Dissection of Gastric Neoplasia

Overview

Journal J Int Med Res

Publisher Sage Publications

Specialty General Medicine

Date 2019 Mar 1

PMID 30816056

Citations 10

Authors

Hiroyuki Komori

Hiroya Ueyama

Akihito Nagahara

Yoichi Akazawa

Tsutomu Takeda

Kohei Matsumoto

Kenshi Matsumoto

Daisuke Asaoka

Mariko Hojo

Takashi Yao

Sumio Watanabe

Affiliations

Soon will be listed here.

Abstract

Background/aims: Vonoprazan is a new a potassium-competitive acid blocker (P-CAB) that was recently developed in Japan. However, vonoprazan's efficacy in healing gastric ulcers after endoscopic submucosal dissection (ESD) remains controversial. This study aimed to compare the efficacy of P-CABs and proton pump inhibitors (PPIs) in healing post-ESD ulcers.

Materials And Methods: This prospective randomized controlled trial (UMIN000017386) enrolled 40 patients with gastric neoplasia, who underwent ESD at our hospital from April 2015 to January 2016. Before ESD, patients were randomly divided into the following two groups: group V, vonoprazan 20 mg/day; or group R, rabeprazole 10 mg/day. Medications were taken 1 day before to 4 weeks after ESD. The ESD-induced artificial ulcer size was measured just after ESD and 4 weeks after ESD to calculate the reduction rate as follows: (ulcer area 4 weeks after ESD)/(ulcer area just after ESD) × 100.

Results: Eighteen patients in group V and 15 patients in group R were analyzed. The mean reduction rate was significantly different in groups V and R (93.3% vs 96.6%, respectively). Post-ESD bleeding was observed in two patients in group R and drug-induced hepatic injury in one patient in group R.

Conclusion: Rabeprazole facilitated the healing process post-ESD.

Citing Articles

Efficacy and safety of vonoprazan versus proton pump inhibitors in the treatment of peptic ulcer disease: a systematic review and network meta-analysis for randomized controlled trails.

Tian L, Xiang D, Yue F, Li R, Zhou Y Front Nutr. 2024; 11:1436993.

PMID: 39301419 PMC: 11412081. DOI: 10.3389/fnut.2024.1436993.

Vonoprazan vs. Proton Pump Inhibitors for Treatment and Prevention of Gastric and/or Duodenal Ulcers: A Systematic Review with Meta-Analysis.

Simadibrata D, Lesmana E, Pratama M, Sugiharta A, Kalaij A, Fadhilla A Dig Dis Sci. 2024; 69(10):3863-3874.

PMID: 39294424 DOI: 10.1007/s10620-024-08593-5.

The value of oral contrast-enhanced gastric ultrasonography in the diagnosis and staging of benign peptic ulcer.

Mu K, Sun Q, Li X, Du X, Gao H, Zhang W Sci Rep. 2024; 14(1):17390.

PMID: 39075113 PMC: 11286921. DOI: 10.1038/s41598-024-68430-7.

Comparison of vonoprazan and proton pump inhibitors for the treatment of gastric endoscopic submucosal dissection-induced ulcer: an updated systematic review and meta-analysis.

Chen L, Jiang D, Hu D, Cui X BMC Gastroenterol. 2024; 24(1):110.

PMID: 38491413 PMC: 10943859. DOI: 10.1186/s12876-024-03198-8.

Using proton pump inhibitors increases the risk of hepato-biliary-pancreatic cancer. A systematic review and meta-analysis.

Zhou W, Chen X, Fan Q, Yu H, Jiang W Front Pharmacol. 2022; 13:979215.

PMID: 36188583 PMC: 9515471. DOI: 10.3389/fphar.2022.979215.

References

Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D . A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc. 1999; 50(4):560-3. DOI: 10.1016/s0016-5107(99)70084-2. View

Stedman C, Barclay M . Review article: comparison of the pharmacokinetics, acid suppression and efficacy of proton pump inhibitors. Aliment Pharmacol Ther. 2000; 14(8):963-78. DOI: 10.1046/j.1365-2036.2000.00788.x. View

Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D . Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001; 48(2):225-9. PMC: 1728193. DOI: 10.1136/gut.48.2.225. View

Horai Y, Kimura M, Furuie H, Matsuguma K, Irie S, Koga Y . Pharmacodynamic effects and kinetic disposition of rabeprazole in relation to CYP2C19 genotypes. Aliment Pharmacol Ther. 2001; 15(6):793-803. DOI: 10.1046/j.1365-2036.2001.00980.x. View

Gisbert J, Gonzalez L, Calvet X, Roque M, Gabriel R, Pajares J . Proton pump inhibitors versus H2-antagonists: a meta-analysis of their efficacy in treating bleeding peptic ulcer. Aliment Pharmacol Ther. 2001; 15(7):917-26. DOI: 10.1046/j.1365-2036.2001.01012.x. View

Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K . Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc. 2002; 56(4):507-12. DOI: 10.1067/mge.2002.128108. View

Ono H . Endoscopic submucosal dissection for early gastric cancer. Chin J Dig Dis. 2005; 6(3):119-21. DOI: 10.1111/j.1443-9573.2005.00206.x. View

Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S . Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc. 2006; 63(2):243-9. DOI: 10.1016/j.gie.2005.08.002. View

Shiba M, Higuchi K, Kadouchi K, Montani A, Yamamori K, Okazaki H . Risk factors for bleeding after endoscopic mucosal resection. World J Gastroenterol. 2006; 11(46):7335-9. PMC: 4725155. DOI: 10.3748/wjg.v11.i46.7335. View

10.

Watanabe K, Ogata S, Kawazoe S, Watanabe K, Koyama T, Kajiwara T . Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc. 2006; 63(6):776-82. DOI: 10.1016/j.gie.2005.08.049. View

11.

Ji S, Kim H, Kim J, Jee M, Park K, Uh Y . Comparison of the efficacy of rabeprazole 10 mg and omeprazole 20 mg for the healing rapidity of peptic ulcer diseases. J Gastroenterol Hepatol. 2006; 21(9):1381-7. DOI: 10.1111/j.1440-1746.2006.04314.x. View

12.

Ramakrishnan K, Salinas R . Peptic ulcer disease. Am Fam Physician. 2007; 76(7):1005-12. View

13.

Okada K, Yamamoto Y, Kasuga A, Omae M, Kubota M, Hirasawa T . Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc. 2010; 25(1):98-107. DOI: 10.1007/s00464-010-1137-4. View

14.

Tsuji Y, Ohata K, Ito T, Chiba H, Ohya T, Gunji T . Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions. World J Gastroenterol. 2010; 16(23):2913-7. PMC: 2887588. DOI: 10.3748/wjg.v16.i23.2913. View

15.

Hori Y, Imanishi A, Matsukawa J, Tsukimi Y, Nishida H, Arikawa Y . 1-[5-(2-Fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamine monofumarate (TAK-438), a novel and potent potassium-competitive acid blocker for the treatment of acid-related diseases. J Pharmacol Exp Ther. 2010; 335(1):231-8. DOI: 10.1124/jpet.110.170274. View

16.

Matsukawa J, Hori Y, Nishida H, Kajino M, Inatomi N . 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(9):1145-51. DOI: 10.1016/j.bcp.2011.02.009. View

17.

Hori Y, Matsukawa J, Takeuchi T, Nishida H, Kajino M, Inatomi N . A study comparing the antisecretory effect of TAK-438, a novel potassium-competitive acid blocker, with lansoprazole in animals. J Pharmacol Exp Ther. 2011; 337(3):797-804. DOI: 10.1124/jpet.111.179556. View

18.

Burget D, Chiverton S, Hunt R . Is there an optimal degree of acid suppression for healing of duodenal ulcers? A model of the relationship between ulcer healing and acid suppression. Gastroenterology. 1990; 99(2):345-51. DOI: 10.1016/0016-5085(90)91015-x. View

19.

Shin J, Inatomi N, Munson K, Strugatsky D, Tokhtaeva E, Vagin O . Characterization of a novel potassium-competitive acid blocker of the gastric H,K-ATPase, 1-[5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl]-N-methylmethanamine monofumarate (TAK-438). J Pharmacol Exp Ther. 2011; 339(2):412-20. PMC: 3199995. DOI: 10.1124/jpet.111.185314. View

20.

Green Jr F, KAPLAN M, CURTIS L, Levine P . Effect of acid and pepsin on blood coagulation and platelet aggregation. A possible contributor prolonged gastroduodenal mucosal hemorrhage. Gastroenterology. 1978; 74(1):38-43. View