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*Only for medical professionals to read and reference If we open the major consultation platforms and search for patients' consultation messages related to reflux esophagitis (RE), we should sigh with emotion, "The disease has no size, but it is really annoying to repeat it over and over again.
"For example, looking at the following consultation messages, it is found that many patients are suffering from poor treatment effects and repeated illnesses.
The above questions are selected from Good Doctor Online Question 1: What are the reasons for poor RE treatment? Failure to take medicines as prescribed by the doctor, insufficient acid suppression, uncorrected bad living habits, esophageal hypersensitivity, and mental and psychological factors can all lead to poor symptom relief after treatment
.
Among them, "does not follow doctor's orders" and "inadequate acid suppression" are related to drug treatment
.
Proton pump inhibitors (PPIs) are one of the commonly used drugs by gastroenterologists with a wide range of applications
.
But not every gastroenterologist has grasped the properties of PPI
.
PPI acts on the last link of the acid secretion process.
It is absorbed into the blood and reaches the secretory tubules of gastric parietal cells, and all need to convert the inactive benzimidazole and sulfinyl ring into sulfenamide in an acidic environment, and then combine with the stomach.
The cysteines in the internal H+/K+-ATPase form disulfide bonds, thereby irreversibly binding
.
Another new type of acid-suppressing drug, potassium ion-competitive acid blocker (P-CAB), its representative drug Vonolaxan fumarate tablets (referred to as: Vonolaxine) binds H+ in a K+ competitive manner /K+-ATPase plays a role in the K+ binding site
.
What progress does P-CAB Vonola have over PPIs [1-9]? Question 2: Why does RE need maintenance therapy? RE, a common type of gastroesophageal reflux disease (GERD), is not uncommon in gastroenterology outpatient clinics
.
The prevalence of RE among Shanghai residents in China is about 6.
4%[10]
.
Inadequate treatment in patients with RE can lead to a variety of esophageal complications, such as esophageal ulcers, esophageal strictures, esophageal bleeding, Barrett's esophagus, esophageal adenocarcinoma [11-12], and esophageal squamous cell carcinoma [13], and significantly reduce the incidence of esophageal complications.
quality of life
.
Therefore, although the disease of RE will not bring serious adverse consequences in a short period of time, it is a "difficult" disease with the characteristics of repeated recurrence [14]
.
As the number of years of follow-up of patients with RE increased, the proportion of patients with relapse each year increased
.
Maintenance therapy is effective in preventing symptoms and recurrence of esophagitis
.
Randomized controlled trials (RCTs) [15] in the Cochrane, MEDLINE, EMBASE, CINAHL, NRR databases were screened, and 51 studies were finally selected to evaluate the effect of continuous maintenance therapy on GERD (including NERD and RE)
.
The results showed that after maintenance therapy, the risk of recurrence of symptoms was reduced by 46% and the risk of recurrence of esophagitis was reduced by 54%
.
Therefore, maintenance therapy should occupy an important position in the long-term management of RE
.
Question 3: RE is so difficult to deal with, how to regulate the treatment? PPIs or P-CABs are the drugs of choice for the initial treatment of RE, but the duration of treatment varies
.
A meta-analysis[16], comparing the effects of different PPIs in the treatment of RE, showed that regardless of the PPI used, the healing rate of esophagitis after 8 weeks of treatment (77.
5%-94.
1%) was higher than that of 4 weeks of treatment (47.
5%-81.
7%) )
.
The current domestic and foreign guidelines recommend that the course of PPI treatment of reflux esophagitis is 8 weeks [17-18]
.
Duration of treatment: P-CAB vs.
PPIs[19] In addition, the results of a phase III study in Japan [20] showed that the mucosal healing rate of vonolaxan after 8 weeks of treatment was as high as 99.
0%, and the mucosal healing rate of 4 weeks was as high as that of Lansola.
In patients with LA C/D RE, the mucosal healing rates of vonoprazol and lansoprazole for 4 weeks were 96% and 80.
6%, respectively (P=0.
004 ), the 8-week mucosal healing rate of vonoprazol was significantly higher than that of lansoprazole (98.
7% vs 87.
5%, P=0.
0082), and the symptom improvement rate was also more dominant
.
In terms of clinical efficacy, a phase III non-inferiority, open-label, double-blind, parallel-group, multi-center study in Asian non-Japanese population showed [21], 24 weeks of maintenance treatment with vonoprazol once a day Relapse rates were 13.
3% and 12.
3% in the 10 mg and 20 mg groups, respectively, and 25.
5% in the lansoprazole 15 mg group
.
In conclusion, RE is a chronic disease that recurs repeatedly and requires long-term treatment to maintain mucosal healing and effectively relieve symptoms
.
PPI is one of the main drugs currently used in clinical treatment of RE, but it has the problems of insufficient acid suppression, poor patient compliance, and high recurrence rate of maintenance therapy
.
As a new generation of acid-suppressing drugs, vonoprazol has significant clinical advantages in improving medication compliance, promoting mucosal healing, symptom control, and preventing recurrence.
At the same time, compared with PPI, it has cost-effective advantages and is expected to meet more RE requirements.
the patient's treatment needs
.
[14] James W, et al.
Drugs.
2002; 62(8): 1173-1184.
[15] Donnellan C, et al.
Cochrane Database Syst Rev.
2005 Apr 18; (2): CD003245.
[16] Gralnek IM, et al.
Clin Gastroenterol Hepatol.
2006; 4(12): 1452-1458.
[17] Digestive Disease Branch of Chinese Medical Association.
Chinese Journal of Digestion, 2020, 40 (10): 649-663.
[18] Philip O.
Katz,MD,et al.
Am J Gastroenterol 2021;00:1–30.
[19]DDW ePoster Library.
Zhang X.
05/22/21;319972;Sa169.
[20]Ashida K,et al.
Aliment Pharmacol Ther.
2016;43(2):240-51.
[21]Yinglian Xiao, et al.
Data on file.
Review of past issues: Vonolax was approved for reflux esophagitis maintenance treatment indications, reducing the risk of recurrence Significantly lower! About the confusion about GERD diagnosis and treatment, Professor Chen Shengliang, the key point of the essence, finished it in one session! Refractory GERD, where is the "difficulty"? Why? Read the ESNM/ANMS Consensus article to understand the relief of symptoms of reflux esophagitis and the compliance with treatment standards.
What do you think of this indicator? One picture to interpret Treat To Target, one picture to understand the "new" concept of the treatment of reflux esophagitis! New Year's Alert! In addition to gaining three pounds, be careful there is a reflux statement: only for medical and health professionals to use for information 649-663.
[18]Philip O.
Katz,MD,et al.
Am J Gastroenterol 2021;00:1–30.
[19]DDW ePoster Library.
Zhang X.
05/22/21;319972;Sa169.
[20 ]Ashida K, et al.
Aliment Pharmacol Ther.
2016; 43(2): 240-51.
[21] Yinglian Xiao, et al.
Data on file.
Review of past issues: Vonola was approved for reflux esophagitis Maintaining the indications for treatment will significantly reduce the risk of recurrence! About the confusion about GERD diagnosis and treatment, Professor Chen Shengliang, the key point of the essence, finished it in one session! Refractory GERD, where is the "difficulty"? Why? Read the ESNM/ANMS Consensus article to understand the relief of symptoms of reflux esophagitis and the compliance with treatment standards.
What do you think of this indicator? One picture to interpret Treat To Target, one picture to understand the "new" concept of the treatment of reflux esophagitis! New Year's Alert! In addition to gaining three pounds, be careful there is a reflux statement: only for medical and health professionals to use for information 649-663.
[18]Philip O.
Katz,MD,et al.
Am J Gastroenterol 2021;00:1–30.
[19]DDW ePoster Library.
Zhang X.
05/22/21;319972;Sa169.
[20 ]Ashida K, et al.
Aliment Pharmacol Ther.
2016; 43(2): 240-51.
[21] Yinglian Xiao, et al.
Data on file.
Review of past issues: Vonola was approved for reflux esophagitis Maintaining the indications for treatment will significantly reduce the risk of recurrence! About the confusion about GERD diagnosis and treatment, Professor Chen Shengliang, the key point of the essence, finished it in one session! Refractory GERD, where is the "difficulty"? Why? Read the ESNM/ANMS Consensus article to understand the relief of symptoms of reflux esophagitis and the compliance with treatment standards.
What do you think of this indicator? One picture to interpret Treat To Target, one picture to understand the "new" concept of the treatment of reflux esophagitis! New Year's Alert! In addition to gaining three pounds, be careful there is a reflux statement: only for medical and health professionals to use for information
.
Such information is not intended to replace professional medical advice in any way and should not be considered medical advice
.
If such information is used for purposes other than understanding information, this site and the author do not assume relevant responsibilities
.
"For example, looking at the following consultation messages, it is found that many patients are suffering from poor treatment effects and repeated illnesses.
The above questions are selected from Good Doctor Online Question 1: What are the reasons for poor RE treatment? Failure to take medicines as prescribed by the doctor, insufficient acid suppression, uncorrected bad living habits, esophageal hypersensitivity, and mental and psychological factors can all lead to poor symptom relief after treatment
.
Among them, "does not follow doctor's orders" and "inadequate acid suppression" are related to drug treatment
.
Proton pump inhibitors (PPIs) are one of the commonly used drugs by gastroenterologists with a wide range of applications
.
But not every gastroenterologist has grasped the properties of PPI
.
PPI acts on the last link of the acid secretion process.
It is absorbed into the blood and reaches the secretory tubules of gastric parietal cells, and all need to convert the inactive benzimidazole and sulfinyl ring into sulfenamide in an acidic environment, and then combine with the stomach.
The cysteines in the internal H+/K+-ATPase form disulfide bonds, thereby irreversibly binding
.
Another new type of acid-suppressing drug, potassium ion-competitive acid blocker (P-CAB), its representative drug Vonolaxan fumarate tablets (referred to as: Vonolaxine) binds H+ in a K+ competitive manner /K+-ATPase plays a role in the K+ binding site
.
What progress does P-CAB Vonola have over PPIs [1-9]? Question 2: Why does RE need maintenance therapy? RE, a common type of gastroesophageal reflux disease (GERD), is not uncommon in gastroenterology outpatient clinics
.
The prevalence of RE among Shanghai residents in China is about 6.
4%[10]
.
Inadequate treatment in patients with RE can lead to a variety of esophageal complications, such as esophageal ulcers, esophageal strictures, esophageal bleeding, Barrett's esophagus, esophageal adenocarcinoma [11-12], and esophageal squamous cell carcinoma [13], and significantly reduce the incidence of esophageal complications.
quality of life
.
Therefore, although the disease of RE will not bring serious adverse consequences in a short period of time, it is a "difficult" disease with the characteristics of repeated recurrence [14]
.
As the number of years of follow-up of patients with RE increased, the proportion of patients with relapse each year increased
.
Maintenance therapy is effective in preventing symptoms and recurrence of esophagitis
.
Randomized controlled trials (RCTs) [15] in the Cochrane, MEDLINE, EMBASE, CINAHL, NRR databases were screened, and 51 studies were finally selected to evaluate the effect of continuous maintenance therapy on GERD (including NERD and RE)
.
The results showed that after maintenance therapy, the risk of recurrence of symptoms was reduced by 46% and the risk of recurrence of esophagitis was reduced by 54%
.
Therefore, maintenance therapy should occupy an important position in the long-term management of RE
.
Question 3: RE is so difficult to deal with, how to regulate the treatment? PPIs or P-CABs are the drugs of choice for the initial treatment of RE, but the duration of treatment varies
.
A meta-analysis[16], comparing the effects of different PPIs in the treatment of RE, showed that regardless of the PPI used, the healing rate of esophagitis after 8 weeks of treatment (77.
5%-94.
1%) was higher than that of 4 weeks of treatment (47.
5%-81.
7%) )
.
The current domestic and foreign guidelines recommend that the course of PPI treatment of reflux esophagitis is 8 weeks [17-18]
.
Duration of treatment: P-CAB vs.
PPIs[19] In addition, the results of a phase III study in Japan [20] showed that the mucosal healing rate of vonolaxan after 8 weeks of treatment was as high as 99.
0%, and the mucosal healing rate of 4 weeks was as high as that of Lansola.
In patients with LA C/D RE, the mucosal healing rates of vonoprazol and lansoprazole for 4 weeks were 96% and 80.
6%, respectively (P=0.
004 ), the 8-week mucosal healing rate of vonoprazol was significantly higher than that of lansoprazole (98.
7% vs 87.
5%, P=0.
0082), and the symptom improvement rate was also more dominant
.
In terms of clinical efficacy, a phase III non-inferiority, open-label, double-blind, parallel-group, multi-center study in Asian non-Japanese population showed [21], 24 weeks of maintenance treatment with vonoprazol once a day Relapse rates were 13.
3% and 12.
3% in the 10 mg and 20 mg groups, respectively, and 25.
5% in the lansoprazole 15 mg group
.
In conclusion, RE is a chronic disease that recurs repeatedly and requires long-term treatment to maintain mucosal healing and effectively relieve symptoms
.
PPI is one of the main drugs currently used in clinical treatment of RE, but it has the problems of insufficient acid suppression, poor patient compliance, and high recurrence rate of maintenance therapy
.
As a new generation of acid-suppressing drugs, vonoprazol has significant clinical advantages in improving medication compliance, promoting mucosal healing, symptom control, and preventing recurrence.
At the same time, compared with PPI, it has cost-effective advantages and is expected to meet more RE requirements.
the patient's treatment needs
.
[14] James W, et al.
Drugs.
2002; 62(8): 1173-1184.
[15] Donnellan C, et al.
Cochrane Database Syst Rev.
2005 Apr 18; (2): CD003245.
[16] Gralnek IM, et al.
Clin Gastroenterol Hepatol.
2006; 4(12): 1452-1458.
[17] Digestive Disease Branch of Chinese Medical Association.
Chinese Journal of Digestion, 2020, 40 (10): 649-663.
[18] Philip O.
Katz,MD,et al.
Am J Gastroenterol 2021;00:1–30.
[19]DDW ePoster Library.
Zhang X.
05/22/21;319972;Sa169.
[20]Ashida K,et al.
Aliment Pharmacol Ther.
2016;43(2):240-51.
[21]Yinglian Xiao, et al.
Data on file.
Review of past issues: Vonolax was approved for reflux esophagitis maintenance treatment indications, reducing the risk of recurrence Significantly lower! About the confusion about GERD diagnosis and treatment, Professor Chen Shengliang, the key point of the essence, finished it in one session! Refractory GERD, where is the "difficulty"? Why? Read the ESNM/ANMS Consensus article to understand the relief of symptoms of reflux esophagitis and the compliance with treatment standards.
What do you think of this indicator? One picture to interpret Treat To Target, one picture to understand the "new" concept of the treatment of reflux esophagitis! New Year's Alert! In addition to gaining three pounds, be careful there is a reflux statement: only for medical and health professionals to use for information 649-663.
[18]Philip O.
Katz,MD,et al.
Am J Gastroenterol 2021;00:1–30.
[19]DDW ePoster Library.
Zhang X.
05/22/21;319972;Sa169.
[20 ]Ashida K, et al.
Aliment Pharmacol Ther.
2016; 43(2): 240-51.
[21] Yinglian Xiao, et al.
Data on file.
Review of past issues: Vonola was approved for reflux esophagitis Maintaining the indications for treatment will significantly reduce the risk of recurrence! About the confusion about GERD diagnosis and treatment, Professor Chen Shengliang, the key point of the essence, finished it in one session! Refractory GERD, where is the "difficulty"? Why? Read the ESNM/ANMS Consensus article to understand the relief of symptoms of reflux esophagitis and the compliance with treatment standards.
What do you think of this indicator? One picture to interpret Treat To Target, one picture to understand the "new" concept of the treatment of reflux esophagitis! New Year's Alert! In addition to gaining three pounds, be careful there is a reflux statement: only for medical and health professionals to use for information 649-663.
[18]Philip O.
Katz,MD,et al.
Am J Gastroenterol 2021;00:1–30.
[19]DDW ePoster Library.
Zhang X.
05/22/21;319972;Sa169.
[20 ]Ashida K, et al.
Aliment Pharmacol Ther.
2016; 43(2): 240-51.
[21] Yinglian Xiao, et al.
Data on file.
Review of past issues: Vonola was approved for reflux esophagitis Maintaining the indications for treatment will significantly reduce the risk of recurrence! About the confusion about GERD diagnosis and treatment, Professor Chen Shengliang, the key point of the essence, finished it in one session! Refractory GERD, where is the "difficulty"? Why? Read the ESNM/ANMS Consensus article to understand the relief of symptoms of reflux esophagitis and the compliance with treatment standards.
What do you think of this indicator? One picture to interpret Treat To Target, one picture to understand the "new" concept of the treatment of reflux esophagitis! New Year's Alert! In addition to gaining three pounds, be careful there is a reflux statement: only for medical and health professionals to use for information
.
Such information is not intended to replace professional medical advice in any way and should not be considered medical advice
.
If such information is used for purposes other than understanding information, this site and the author do not assume relevant responsibilities
.
