Are You Abreast About Diverse Gastric Ulcer Types and the Clinical Benefits of Vonoprazan Against Them?

Peptic ulcer disease (PUD) is a digestive tract injury that causes mucosal breaks greater than 3–5 mm with a visible depth reaching the submucosa.¹ It mainly occurs in the stomach and proximal duodenum but may involve the lower esophagus, distal duodenum, or jejunum.^1,2 The global PUD prevalence was around 8.09 million in 2019, indicating an approximately 26% increase since 1990. Regionally, South Asia had the highest age-standardized prevalence rate of around 157/100,000 individuals in 2019.¹

Helicobacter pylori (H. pylori) infection and non-steroidal anti-inflammatory drugs (NSAIDs) are a few leading causes of gastric and duodenal ulcers.³ However, the prime cause of peptic ulcer bleeding has moved from H. pylori infection to long-term NSAID use. Hence, managing patients with PUD who require long-term NSAIDs is of utmost importance.⁴

Vonoprazan is a novel gastric acid suppressant, which is fast-acting and does not require acid-induced activation.^4,5 A 12-month prospective, observational study assessed vonoprazan for the prevention of gastric and duodenal ulcer recurrence in patients on long-term NSAIDs. The overall incidence rate for ulcer recurrence was 1.04% and for adverse drug reactions was 0.71%.⁴

Furthermore, endoscopic submucosal dissection (ESD) is a standard procedure for treating early-stage gastrointestinal cancers but can lead to bleeding and perforations. Although proton pump inhibitors help to heal ESD-induced lesions, some ulcers fail to heal, which necessitates alternative therapy. This is where vonoprazan can come to the rescue for reported efficacy against ESD-induced ulcers.⁵

Conclusion

Vonoprazan is a novel gastric acid suppressant, with reported activity against NSAID- and ESD-induced ulcers.^4,5

CTA: Let us listen to the expert, Dr. Philip Abraham, and dig out the clinical efficacy and safety of vonoprazan in ulcer prevention.

1. Xie X, Ren K, Zhou Z, et al. The global, regional and national burden of peptic ulcer disease from 1990 to 2019: A population-based study. BMC Gastroenterol. 2022;22(1):58.
2. Malik TF, Gnanapandithan K, Singh K. Peptic ulcer disease. [Updated 2023 Jun 5]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK534792/. Accessed on: 18 November 2024.
3. Almadi MA, Lu Y, Alali AA, et al. Peptic ulcer disease. Lancet. 2024;404(10447):68–81.
4. Kawai T, Suzuki C, Honda Y, et al. Long-term safety and effectiveness of vonoprazan for prevention of gastric and duodenal ulcer recurrence in patients on nonsteroidal anti-inflammatory drugs in Japan: A 12-month post-marketing surveillance study. Expert Opin Drug Saf. 2023;22(5):425–431.
5. Kawai D, Takenaka R, Ishiguro M, et al. Vonoprazan versus lansoprazole in the treatment of artificial gastric ulcers after endoscopic submucossal dissection: A randomized, open-label trial. BMC Gastroenterol. 2021;21(1):236.