Therapeutic Research

Abstract

Background：The potassium‒competitive acid blocker has potent acid‒inhibitory effects. We aimed to evaluate the effects of vonoprazan in patients with treatment‒refractory gastroesophageal reflux disease（GERD）. Methods：In this first head‒to‒head, single‒center, 4‒week, randomized, open‒label, parallel group study, we enrolled 80 GERD patients diagnosed with a Frequency Scale for the Symptoms of GERD（FSSG）total score ≥8 after at least 8 weeks of treatment with a standard‒dose of proton pump inhibitors, who were randomly and equally allocated to vonoprazan 20 mg/day or esomeprazole 20 mg/day during 4 weeks. We assessed the FSSG and Gastrointestinal Symptom Rating Scale（GSRS） scores before and 1, 2, and 4 weeks after switching and the changes in patient satisfaction using a patient diary. We compared the therapeutic efficacy between groups. Results：The FSSG and GSRS total scores significantly decreased from 1 week after switching to vonoprazan or esomeprazole than with previous treatment（p＜0.05）. After the 1‒week treatment, the acid reflux‒related scores of the FSSG in the vonoprazan group were lower than in the esomeprazole group（not significant）. The patient satisfaction scores in the vonoprazan group tended to be higher than in the esomeprazole group until day 11. However, the degree of improvement of the acid reflux‒related symptom score of the FSSG was significantly higher in the esomeprazole group than in the vonoprazan group after the 4‒week treatment（p＜0.05）. Conclusions：Vonoprazan quickly decreased the incidence of GERD symptoms in patients with treatment‒refractory GERD. However, acid reflux‒related symptom relief at 4 weeks was significantly higher with esomeprazole than with vonoprazan.