Treatment Strategy for Standard-Dose Proton Pump Inhibitor-Resistant Reflux Esophagitis

• Published in: Journal of Nippon Medical School Vol. 84; no. 5; pp. 209 - 214
• Main Author: Iwakiri, Katsuhiko
• Format: Journal Article
• Language: English
• Published: Japan The Medical Association of Nippon Medical School 2017
• Subjects: Clinical Trials as Topic; Drug Administration Schedule; Drug Resistance; Drug Substitution; esophageal motility; Esophagitis, Peptic - drug therapy; Gastroenterology - organization & administration; Humans; Japan; Life Style; potassium-competitive acid blocker (P-CAB); PPI-refractory reflux esophagitis; Practice Guidelines as Topic; Proton Pump Inhibitors - administration & dosage; proton-pump inhibitor (PPI); Pyrroles - administration & dosage; reflux esophagitis; Severity of Illness Index; Societies, Medical; Sulfonamides - administration & dosage; Treatment Outcome; PPI-refractory reflux esophagitis; proton-pump inhibitor (PPI); reflux esophagitis; potassium-competitive acid blocker (P-CAB); esophageal motility
• ISSN: 1345-4676; 1347-3409
• DOI: 10.1272/jnms.84.209

Reflux esophagitis is characterized by excessive esophageal acid exposure. To treat reflux esophagitis, it is necessary to reduce excessive esophageal acid exposure to within the normal range. The first-line drug for the treatment of reflux esophagitis is a standard-dose proton-pump inhibitor (PPI), which is also recommended by the Evidence-based Clinical Practice Guidelines 2015 for gastroesophageal disease of the Japanese Society of Gastroenterology. It has been reported that the response to a standard dose of PPI in patients with mild reflux esophagitis is 90-100%, and that in patients with severe reflux esophagitis is 80-85%. However, PPI-resistant reflux esophagitis has been increasing. When the standard dose of PPI is not effective, modification of the lifestyle with PPI therapy, switching to another PPI, or a change in the administration method (before meals), as well as double-dose PPI (in divided doses), may be effective. In addition, vonoprazan (potassium-competitive acid blocker), which has rapid and potent acid-suppressive effects, became available in February 2015 in Japan. In the clinical trial data, vonoprazan is very effective for reflux esophagitis. However, clinical data on vonoprazan are still insufficient. The establishment of a new treatment for reflux esophagitis taking advantage of the rapid and potent acid-suppressive effects is awaited.