Efficacy of vonoprazan for refractory reflux esophagitis after esophagectomy.

BACKGROUND Refractory reflux esophagitis (RRE), unresponsive to conventional proton-pump inhibitors (PPIs) is a complication in esophagectomy with gastric pull-up. Vonoprazan, a novel potassium-competitive acid blocker, has been available in Japan since 2015. Here, we investigated the efficacy of vonoprazan on PPI-resistant RRE after esophagectomy with gastric pull-up. METHODS This was a single-center retrospective study. We used the revised Los Angeles (r-LA) classification based on the Los Angeles (LA) classification and the modified Los Angeles (m-LA) classification to evaluate abnormal forms of mucosal breaks such as spreading laterally consistently. Patients who underwent esophagectomy with gastric pull-up and had RRE grade B-D as per the r-LA classification, despite using standard dose PPIs or double-dose of rabeprazole, were included. Sixteen patients who switched to vonoprazan (20 mg/day) and 14 patients who continued PPIs were assigned to the vonoprazan and PPI groups, respectively. Endoscopic observations were reviewed by three endoscopists using the r-LA classification to ensure consistent diagnosis, while treatment arm and patient information were blinded to evaluators. We defined mucosal breaks that improved by at least one grade after treatment as improved mucosa and recovery to grade M or N as mucosal healing. RESULTS The percentage of patients with improved mucosa in the vonoprazan and PPI groups was 81.3% and 14.3%, respectively (p<0.001). The rate of mucosal healing was 68.8% and 7.1%, respectively (p=0.001). CONCLUSIONS Vonoprazan significantly improved PPI-resistant RRE after esophagectomy with gastric pull-up.