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Prevalence of behavioral disorders in patients with vonoprazan-refractory reflux symptoms

  • Original Article—Alimentary Tract
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Abstract

Background

Behavioral disorders, such as supragastric belching (SGB) and rumination syndrome (RS), which may be treated by cognitive behavioral therapy, are common in patients with reflux symptoms refractory to proton pump inhibitors (PPI). Vonoprazan (VPZ) has been used as a new type of acid inhibitor in Japan since 2015. We herein investigated the prevalence of behavioral disorders in patients with VPZ-refractory reflux symptoms and attempted to identify predictive factors.

Methods

We retrospectively analyzed esophagogastroduodenograms, high-resolution manometry, and 24-h multiluminal impedance pH-metry (MIIpH) in patients with VPZ-refractory reflux symptoms (heartburn or regurgitation) receiving 20 mg VPZ who underwent these tests at our hospital between January 2015 and April 2020. Patients were divided as follows: non-erosive reflux disease with pathological esophageal acid exposure (NERD), functional heartburn (FH), reflux hypersensitivity (RH), excessive (> 13 per day) SGB, and possible RS based on MIIpH parameters.

Results

Among 49 patients, 6 (12.2%) had SGB, 4 (8.2%) possible RS, 29 (59.2%) FH, 9 (18.4%) RH, and 1 (2%) NERD. Possible RS patients had more postprandial non-acid reflux events than FH patients (p < 0.05). The multivariate logistic regression analysis did not identify any predictive factors with statistical significance.

Conclusion

More than 20% patients with VPZ-refractory reflux symptoms had behavioral disorders. The use of HRM and MIIpH may be clinically relevant for a better diagnosis and more specific treatment.

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Acknowledgements

The authors thank Ms. Satoko Nishimura for her administrative assistance.

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Authors and Affiliations

  1. Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Yoshimasa Hoshikawa, Shintaro Hoshino, Noriyuki Kawami & Katsuhiko Iwakiri

Authors
  1. Yoshimasa Hoshikawa
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  2. Shintaro Hoshino
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  3. Noriyuki Kawami
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  4. Katsuhiko Iwakiri
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Contributions

YH contributed to the study conception and design, analyzed clinical tests, performed statistical analyses, and wrote the draft. SH and NK performed and analyzed the clinical tests. KI contributed to the study conception and design and wrote the draft. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Katsuhiko Iwakiri.

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Conflict of interest

Katsuhiko Iwakiri has received lecture fees from Takeda Pharmaceutical Co., Ltd. and Otsuka Pharmaceutical Co., Ltd. The remaining authors declare that they have no conflicts of interest.

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Hoshikawa, Y., Hoshino, S., Kawami, N. et al. Prevalence of behavioral disorders in patients with vonoprazan-refractory reflux symptoms. J Gastroenterol 56, 117–124 (2021). https://doi.org/10.1007/s00535-020-01751-2

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  • DOI: https://doi.org/10.1007/s00535-020-01751-2

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