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.

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.

• Authors: Hiroyuki Komori, Hiroya Ueyama, Akihito Nagahara, Yoichi Akazawa, Tsutomu Takeda, Kohei Matsumoto, Kenshi Matsumoto, Daisuke Asaoka, Mariko Hojo, Takashi Yao, Sumio Watanabe
• Journal: The Journal of international medical research (J Int Med Res) Vol. 47 Issue 4 Pg. 1441-1452 (Apr 2019) ISSN: 1473-2300 [Electronic] England
• PMID: 30816056 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• 1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine
• Proton Pump Inhibitors
• Pyrroles
• Sulfonamides

Topics

• Aged
• Endoscopic Mucosal Resection (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Male
• Postoperative Complications (drug therapy)
• Prognosis
• Prospective Studies
• Proton Pump Inhibitors (therapeutic use)
• Pyrroles (therapeutic use)
• Stomach Neoplasms (surgery)
• Stomach Ulcer (drug therapy, etiology, pathology)
• Sulfonamides (therapeutic use)
• Wound Healing (drug effects)