Treatment Of Erosive Esophagitis Research Articles

Comparison of Tegoprazan and Lansoprazole in Patients With Erosive Esophagitis up to 4 Weeks: A Multi-Center, Randomized, Double-Blind, Active-Comparator Phase 4 Trial.

The aims of this study were to confirm the non-inferiority of tegoprazan to lansoprazole up to week 4 in patients with erosive esophagitis (EE) and to evaluate its effectiveness in rapid mucosal healing and symptom relief at week 2. In this multi-center, randomized, double-blind, active-comparator non-inferiority trial, 218 patients with endoscopically confirmed EE (Los Angeles Classification Grades A-D) were randomly allocated to either the tegoprazan (50 mg) or lansoprazole (30 mg) group. The primary endpoint was the cumulative proportion of patients with healed EE up to week 4, as confirmed through endoscopy. The proportion of patients with healed EE at week 2 was also evaluated. Furthermore, CYP2C19 genotypes, symptoms, safety, and tolerability were assessed. In the full-analysis set, 103 and 109 participants in the tegoprazan and lansoprazole groups, respectively, were analyzed. The cumulative healing rates up to week 4 were 95.2% (98/103) and 86.2% (94/109) (difference [95% confidence interval], 8.91 [1.22-16.59]; p < 0.0001 for non-inferiority and 0.0266 for superiority), while those at week 2 were 88.4% (91/103) and 82.6% (90/109) (5.78 [-3.66-15.22], p = 0.0005 for non-inferiority) for tegoprazan and lansoprazole, respectively. Tegoprazan showed consistent healing rates regardless of CYP2C19 genotypes. Tegoprazan was superior to lansoprazole in the treatment of EE up to 4 weeks. Further studies are necessary to confirm these findings and clarify the superiority of tegoprazan, especially in the treatment of severe EE. ClinicalTrials.gov identifier: NCT05267743.

Comparison of Los Angeles Grades of Erosive Esophagitis Scored by Local Investigators vs Central Adjudicators in a Clinical Trial

Approximately 30% of patients with typical gastroesophageal reflux disease (GERD) symptoms have endoscopic evidence of erosive esophagitis (EE).1 The severity of EE is commonly graded using the Los Angeles (LA) classification system as grade A (minimal) to D (very severe), depending on the extent of endoscopically visible mucosal breaks (Supplementary Figure1).2 Accurate grading of EE severity is crucial in clinical trials of medical EE treatments, as EE severity strongly influences both initial rates of healing and the likelihood of recurrence during maintenance treatment.3,4 Almost all EE treatment studies have relied exclusively on local investigators' grading of EE severity to determine study eligibility and response to treatment. Those few studies that included central adjudication did not assess the reliability of grading by local investigators.5 Unlike typical studies of EE treatment, the phase III clinical trial of vonoprazan versus lansoprazole for the treatment of EE (NCT04124926) mandated central adjudication of endoscopic grading for study participation.6 The aim of the present investigation was to evaluate the rate of agreement between local investigators and central adjudicators for EE grading during screening for entrance into that clinical trial.

Potassium-competitive acid blockers and proton-pump inhibitors for healing of erosive esophagitis: a systematic review and network meta-analysis.

Proton-pump inhibitors (PPIs) and potassium-competitive acid blockers (P-CABs) are recommended for erosive esophagitis (EE), with good safety and tolerance. However, it is unclear which is the best treatment option for EE. This study aimed to evaluate the comparative efficacy of P-CABs and PPIs for healing EE patients, seeking an appropriate treatment choice in the 4- or 8-week treatment and standard or double dose. A systematic review and network meta-analysis. Relevant databases were searched to collect randomized controlled trials of PPIs and P-CABs in the treatment of EE up to 31 May 2023. Studies on standard or double-dose PPIs or P-CABs which were published in English and assessed 4- or 8-week healing effects in EE were included. A network meta-analysis was performed to evaluate the efficacy of the treatments under the frequentist framework. Sensitivity and subgroup analyses of patients with different baseline EE were also conducted. In all, 34 studies involving 25,054 patients and 9 PPIs, 6 P-CABs, or placebo treatment interventions were included. The pooled 4-week healing rate was significantly statistically lower than the pooled 8-week healing rate for most treatments. Besides, the higher healing rate of double-dose treatment than standard-dose treatment was not observed in the initial treatment of most drugs. The main analysis only included studies conducted for both patients with and without severe EE at baseline, and the proportion of severe EE included in the study was >10%, Keverprazan 20 mg qd ranked best with a surface under the cumulative ranking curve (SUCRA) value of 84.7, followed by Ilaprazole 10 mg qd with a SUCRA value of 82.0, for the healing rate at 8 weeks. Sensitivity analysis showed that the results were robust. Subgroup analysis showed that most P-CABs had higher healing rates than PPIs, particularly for patients with severe EE. And the healing rate of Keverprazan 20 mg qd at 8 weeks ranked best in the subgroup without or with severe EE at baseline. This study showed that an 8-week treatment seemed more effective than the 4-week treatment for healing EE patients. The healing effect of Keverprazan (20 mg qd) ranked best in 8-week treatment, for both severe and non-severe EE patients. The study protocol was registered with INPLASY (registration number INPLASY2023120053).

Efficacy and safety of HIP1601 (dual delayed-release esomeprazole) 40 mg in erosive esophagitis compared to HGP1705 (delayed-release esomeprazole) 40 mg: a multicenter, randomized, double-blind, non-inferiority study

BackgroundProton-pump inhibitors (PPIs) are the most effective drugs for treating acid-related disorders. However, once-daily dosing with conventional PPIs fail to fully control acid secretion over 24 h. This study aimed to compare the efficacy and safety of HIP1601 (dual delayed-release esomeprazole) and HGP1705 (delayed-release esomeprazole) in patients with erosive esophagitis (EE).MethodsWe enrolled 213 patients with EE randomized in a 1:1 ratio to receive 40 mg HIP1601 (n = 107) or HGP1705 (n = 106) once daily for 4 or 8 weeks. The primary endpoint was the EE healing rate, confirmed by endoscopy up to week 8. GERD-related symptoms and treatment-emergent adverse events were compared between both groups.ResultsBy week 8, the estimated healing rates of EE were 97.8% and 96.8% in the HIP1601 and HGP1705 groups, respectively, with a 95% confidence interval of -4.7 to 7.2. After 4 or 8 weeks of treatment, the EE healing rate at week 4, complete resolution rate of symptoms, time to sustained resolution of symptoms, and number of rescue medications used were similar in both groups. The proportion of heartburn- and acid regurgitation-free nights by week 4 were higher in the HIP1601 group compared to the HGP1705 group, but the difference did not reach clinical significance (87.7% vs. 85.8%, P = 0.514, 87.5% vs. 85.8%, P = 0.774). The number of adverse events did not differ significantly between the two groups.ConclusionsThe efficacy and safety of HIP1601 40 mg were comparable to those of HGP1705 40 mg for the treatment of EE and symptomatic improvement of GERD.Trial registrationNCT04080726 (https://classic.clinicaltrials.gov/ct2/show/NCT04080726), registration date: 25/10/2018.

Risk factors for symptom relapse in patients with Los Angeles Grade A/B erosive esophagitis

AbstractRecurrence of reflux symptoms following discontinuing proton pump inhibitor therapy is a common problem in the treatment of gastroesophageal reflux disease. We aim (1) to examine the cumulative 12‐week incidence of symptom relapse following 8‐week proton pump inhibitor therapy in patients with Los Angeles grade A/B erosive esophagitis and (2) to search the risk factors predicting symptom relapse in the treatment of erosive esophagitis. From June 2010 to May 2019, patients with Los Angeles Grade A/B erosive esophagitis receiving esomeprazole therapy (40 mg qd) for 8 weeks followed by complete symptom resolution were included in this study. Subjects received on‐demand esomeprazole treatment for 12 weeks and underwent prospective follow‐up for reflux symptoms. 12‐week cumulative incidence of symptom relapse was assessed, and predictive risk factors for symptom relapse were determined by multivariate analysis. 219 patients with Los Angeles Grade A/B erosive esophagitis who achieved complete symptom resolution following 8‐week esomeprazole therapy were enrolled. During the 12‐week follow‐up period, 110 patients (50.2%) developed symptom relapse. Univariate analysis showed that symptom relapse was significantly associated with advanced age, smoking, and the presence of heartburn (p = .003, .015, and .042, respectively). Multivariate analysis with stepwise logistic regression showed that only advanced age (95% confidence interval [CI]: 1.45–5.15) and smoking (95% CI: 1.30–6.58) were independent factors predicting symptom relapse with odds ratios of 2.74 and 2.92, respectively. The 12‐week cumulative incidence of symptom relapse following initial proton pump inhibitor treatment in patients with Los Angeles grade A/B erosive esophagitis is 50.2%. Advanced age and smoking are independent risk factors predicting symptom relapse following treatment in patients with mild erosive esophagitis.

Role of Potassium-competitive Acid Blockers in the Treatment of Gastric Acid-related Disorders

Owing to their superior pharmacokinetic and pharmacodynamic profiles, potassium-competitive acid blockers (P-CABs) score over proton pump inhibitors (PPIs) in the treatment of gastric acid-related disorders and may provide clinical benefit in the management of these conditions. Previous studies have compared P-CABs with PPIs for treatment of gastric acid-related disorders, and current data show that P-CABs are non-inferior to PPIs in the treatment of erosive esophagitis and as maintenance therapy. P-CABs are useful for effective healing and as maintenance medications in patients with severe esophagitis. These drugs also aid with healing of peptic ulcers and artificial ulcers secondary to gastric endoscopic submucosal dissection (ESD). Few studies have discussed prevention of delayed ulcer bleeding after gastric ESD and ulcers associated with long-term nonsteroidal anti-inflammatory drug administration. Well-controlled, large-scale prospective studies are warranted in future to compare P-CABs with PPIs.

Review of the clinical development of fexuprazan for gastroesophageal reflux-related disease.

Proton pump inhibitors (PPIs) are a mainstay treatment for acid peptic disorders such as gastroesophageal reflux disease (GERD). Although PPIs are considered first-line medications for acid suppression, they have notable limitations such as requiring acid-mediated activation, short half-life and duration of action, and metabolic variability. Fexuprazan is a newly developed potassium-competitive acid blocker (P-CAB), which inhibits acid generation and secretion in a competitive and reversible manner. Fexuprazan, like other P-CABs, has significantly different pharmacodynamic and pharmacokinetic properties than PPIs with potential advantages including rapid, robust, and durable acid suppression, lack of CYP2C19 metabolism, independence from food intake, and no requirement for activation into an active form. Completed clinical trials of fexuprazan have demonstrated comparable efficacy to PPIs for the healing of erosive esophagitis and relief of GERD-related esophageal symptoms without concerning safety signals. Ongoing clinical trials are evaluating fexuprazan for the prevention of NSAID-induced peptic ulcer disease, non-erosive GERD, and acute and chronic gastritis, as well as healing efficacy and maintenance of erosive esophagitis (EE). Fexuprazan is approved in South Korea for the treatment of EE and at the time of this writing is being considered for regulatory approval in several other countries. In this article, we summarize and discuss the pharmacology, efficacy, and safety of fexuprazan.

Efficacy and safety of proton pump inhibitors versus vonoprazan in treatment of erosive esophagitis: A PRISMA-compliant systematic review and network meta-analysis.

Proton-pump inhibitors (PPIs) and vonoprazan are recommended as first-line therapies for erosive esophagitis (EE). However, it is uncertain how the magnitude of efficacy and safety of first-line therapy, the choice of individual PPIs or vonoprazan in the treatment of EE remains controversial. This study aimed to evaluate the efficacy and safety of vonoprazan and PPIs in healing esophageal mucosal injury in patients with EE. Relevant databases were searched to collect randomized controlled trials of proton pump inhibitors and vonoprazan in the treatment of reflux esophagitis up to December 2021. Studies on standard-dose PPIs or vonoprazan that were published in Chinese or English and assessed healing effects in EE were included in the analysis. Stata16.0 was used to conduct a network Meta-analysis to evaluate the efficacy and safety of the treatment. A total of 41 literatures were included with 11,592 enrolled patients. For the endoscopic cure rate, all the PPIs and vonoprazan significantly improve compared to Placebo; Based on the surface under the cumulative ranking curve, Ilaprazole ranked first, followed by esomeprazole, vonoprazan, pantoprazole, lansoprazole, omeprazole, rabeprazole and placebo therapy ranked the last. For the rate of adverse events, there was no significant difference among all the PPIs, vonoprazan, and placebo. Ilaprazole, esomeprazole and vonoprazan have more advantages in mucosal erosion healing, there was no significant difference in the comparative safety among all interventions.

The role of vonoprazan in patients with erosive esophagitis.

Acid suppression is the primary therapy for erosive esophagitis (EE). Although proton pump inhibitors (PPIs) are considered as the first-line medication for EE, 10–20% of patients with Los Angeles C and D grade EE do not gain complete mucosal healing and symptom control despite 8-week double-dose PPI treatment. Vonoprazan is a novel potassium-competitive acid blocker (P-CAB), which blocks the H+, K+-adenosine triphosphatase enzymes in a K+-competitive and reversible manner. Vonoprazan exhibits different pharmacological and pharmacokinetic profiles from conventional PPIs, and has a rapid, potent and sustained acid inhibitory effect. In this review, we summarized and discussed current evidence regarding the role of vonoprazan in terms of mucosal healing, maintaining remission and symptom relief for the management of EE, including the initial and maintenance treatment of EE, as well as for PPI-resistant EE patients. Safety concerns and cost-effectiveness analysis of vonoprazan were also mentioned in the article. As a potent and well-tolerated acid blocker, vonoprazan has the potential to become a novel option for the management of EE.

IN-VITRO EVALUATION OF DIFFERENT AVAILABLE BRANDS OF DEXLANSOPRAZOLE MR CAPSULES

Dexlansoprazole delayed release is a newly developed class of Proton Pump Inhibitor (PPI). The drug is effective in the treatment of erosive esophagitis, maintenance of eosinophilic esophagitis and relief of heartburn. Additionally, it is also beneficial in the treatment of heartburn with symptomatic gastroesophageal reflux disease. The drug offers the advantage of no dosage adjustment in patients with hepatic impairment. Dexlansoprazole inhibits the stomach acid secrection by specific inhibition of the hydrogen-potassium–ATPase in parietal cells of stomach.

The current state of the art in the treatment of erosive esophagitis

The current state of the art in the treatment of erosive esophagitis

Optimal acid suppressive treatment for adequate symptom relief and prevention of the complications of gastroesophageal reflux disease: differences in long-term clinical course and pathophysiology among disease subtypes

Gastroesophageal reflux disease (GERD) is a chronic long-standing disease. Most patients with GERD are thought to require long-term treatment with acid suppressants, with proton pump inhibitors being the drugs of choice in managing these patients. However, there has been no consensus about the frequency of spontaneous remission of GERD. Furthermore, the duration of treatment is individually based, and the end-point of treatment is also not clear. As the symptoms of GERD may be intermittent or occur on most days of the week, treatment may be short term, lasting 8–12 weeks, or long term, lasting more than 1 year. Moreover, treatment may be continuous, intermittent, or on-demand. In contrast, maintenance therapy consists of the lowest proton pump inhibitor dose necessary for adequate symptom relief and prevention of GERD-related complications. GERD has been classified into three subgroups based on endoscopic severity: non-erosive reflux disease (NERD), mild erosive esophagitis (EE), and severe EE. Because these three subgroups differ in long-term clinical course and pathophysiology, their treatment strategies should differ. Treatment of severe EE should include two clinical goals: relief of GERD symptoms and prevention of EE-related complications, such as esophageal ulcer bleeding and/or strictures. However, because mild EE, including NERD, rarely progresses to severe EE during symptom-driven treatment, treatment of these patients should have one clinical goal: relief of GERD symptoms.

Profile of patients presenting with heartburn and treatment of erosive esophagitis with Esomeprazole - an experience

It`s a descriptive analytical study done at Lahore Gut and Liver Centre during March 2005 to February 2006. Material & method: 260 patients who presented with heartbum were included in the study. Their symptoms are recorded and graded a/c to severity. Upper GI Endoscopy done to grade the mucosal injury a/c to LA Classification. First forty patients who were having Erosive Esophagitis were started on Esomeprazole 40mg once daily. Patient reviewed after every 2 weeks for symptom improvement and adverse events. After 8 weeks UGIT Endoscopy repeated to see mucosal improvement in those patients in which mucosal break was recorded at the start of therapy (a/c to LA Classification). Dose increment to 40mg twice a day made, if no symptomatic improvement in 2 weeks. Results: 260 patients in the range of 16 to 75 years, with mean age 37 years, with male to female 1:1.4, mean BMI 29%. 40% were smokers and 10% taking regular Alcohol (25 units/week), 12% got DM. 3% got Chronic Liver Disease due to HCV infection. Regurgitation 75%, Nausea/Vomiting 30% Chest Pain. 20% dysphagic 10%, water brash 60%, Epigastric pain 30%, Early Satiety 35%, Bloating 20%. 95 patients (36.53%) had Erosive Esophagitis; 155 patients (59.6%) no evidence of mucosal injury; 10 patients (3.84%) got Barret`s Eshophegitis. First forty patients who showed Erosive Esophagitis has age range of 16-60 years. 38 patients completed the therapy, 2 patients lost to follow up. Main age was 35 years with male to female ratio of 1.2:1.45% patients were smokers, average BMI of 30. An improvement trend in symptoms by at least 2 levels a/c scale was seen in 20% in 2 weeks, 50% by 4 weeks and 95% by 8 weeks. At the end of study (8 weeks) improvement in mucosal change is 100%. The adverse events noted are bloating 45% and loose stools and headache 20% each. Conclusion: Various overlap symptoms are common in GERD. Endoscopic negative GERD is common, Esomeprazole is effective in GERD.

Tu1059 A Phase 3, Randomized, Double-Blind, Multicenter Study to Evaluate the Efficacy and Safety of TAK-438 (20 mg Once-Daily) Compared to Lansoprazole (30 mg Once-Daily) in Patients With Erosive Esophagitis

Introduction: Vonoprazan fumarate (TAK-438), a novel class of acid suppressant referred to as a potassium-competitive acid blocker (P-CAB), has been shown in animal models to exert more potent and sustained acid-inhibitory effects than PPIs. In addition, in a phase 2, dose-ranging study in Japanese patients with erosive esophagitis (EE), the non-inferiority of all TAK-438 doses (5, 10, 20 and 40 mg) to lansoprazole (LPZ) 30 mg was confirmed, and 20 mg was recommended as the clinical dose (DDW2013). Aims: To confirm the efficacy of TAK-438 in patients with EE of Los Angeles Classification (LA Classification) Grades A to D by verifying the non-inferiority of TAK-438 to LPZ. Methods: This was a phase 3, randomized, double-blind, parallel-group, multicenter study to verify the non-inferiority of TAK-438 (20 mg once-daily) to LPZ (30 mg once-daily) in patients with EE. This study consisted of 2 periods; an observation period of 3 to 7 days and a double-blind treatment period of 8 weeks. The subjects' LA Classification Grades at the start of the observation period were used as stratification factors (Grade A/B or C/D). The subjects with endoscopically confirmed healing of EE 2, 4, or 8 weeks after the start of the treatment were regarded as having completed the study. Results: A total of 409 subjects were randomized. The primary endpoint, EE healing rate after 8 weeks of treatment was 99.0% in the TAK-438 group and 95.5% in the LPZ group. In addition to the non-inferiority, the superiority of TAK-438 to LPZ was verified. The EE healing rate after 2 weeks of treatment in the TAK-438 group (90.7%) was also superior to that observed in the LPZ group (81.9%). Furthermore, the EE healing rate after 4 weeks of treatment with TAK-438 (96.6%) was non-inferior to that after 8 weeks of treatment with LPZ (95.5%). Notably, in subjects with baseline LA Classification Grade C or D, the EE healing rate after 8 weeks of treatment was higher in the TAK-438 group compared with the LPZ group (98.7% vs 87.5%, respectively). The incidences of treatment-emergent adverse events (TEAE) were similar between the groups; 22.2% in the TAK-438 group, 22.3% in the LPZ group. The most common TEAE was nasopharyngitis (3.4% in the TAK-438 group and 4.0% in the LPZ group). Conclusion: The superiority of TAK-438 20 mg compared with LPZ 30 mg was verified for the primary endpoint, EE healing rate after 8 weeks of treatment. Furthermore, the non-inferiority of 4 weeks treatment with TAK-438 20 mg compared with 8 weeks treatment with LPZ 30 mg was confirmed. Even for subjects with severe baseline Grade C or D, treatment with TAK-438 was highly effective. These results demonstrate the rapid and potent therapeutic effect of TAK-438 20 mg, once daily, for the treatment of EE. The safety profile of TAK-438 was similar to that of LPZ and TAK-438 was safe and well tolerated in patients with EE.

Diagnosis and Management of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is one of the most common disorders in medical practice. It is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics in the United States. Apart from the economic burden of the disease and its impact on quality of life, GERD is the most common predisposing factor for esophageal adenocarcinoma [1]. Recently, many important issues have emerged regarding the classification, pathogenesis, natural history, and treatment of GERD. Although use of proton-pump inhibitor (PPI) is the treatment of choice for GERD, approximately, one-third of patients with GERD fail to response symptomatically to a standard-dose proton-pump inhibitor (PPI), either partially or completely [2]. Additionally, most GERD patients need long-term treatment for frequent relapses after discontinuing acid inhibition therapy. This has led to great interest in new endoscopic therapies for the treatment of this disease. With regard to the diagnosis of GERD, patients with refractory reflux symptoms and normal upper endoscopy are more difficult to diagnose and treat. Combined 24-hour pH and impedance monitoring allows classifying the patients as having true nonerosive reflux disease (NERD), hypersensitive esophagus, or functional heartburn and is helpful for further management of the patients [3]. The main focus of this special issue is on recent advances in the treatment of erosive esophagitis, NERD and Barrett's esophagus. In addition, the emerging diagnostic methods, pharmacological treatments, and endoscopic therapies for GERD are also discussed. The paper entitled “The frequencies of gastroesophageal and extragastroesophageal symptoms in patients with mild erosive esophagitis, severe erosive esophagitis, and Barrett's esophagus, in Taiwan” is the first work simultaneously assessing the differences in reflux symptom profiles among the three different categories of GERD. The data showed that the frequencies of some esophageal and extraesophageal symptoms in patients with Los Angeles grade A/B erosive esophagitis were higher than those in patients with Los Angeles grade C/D erosive esophagitis and Barrett's esophagus. In the paper entitled “Current pharmacological management of gastroesophageal reflux disease,” Y.-K. Wang et al. present the current and developing therapeutic agents for GERD treatment. The efficacies of PPIs and potassium-competitive acid blocker in GERD therapy are well reviewed. Additionally, the article summarizes the development of novel therapeutic agents focusing on the underlying mechanisms of GERD. In the paper entitled “Pharmacological therapy of gastroesophageal reflux in preterm infants,” L. Corvaglia et al. review the pathogenesis, presentation, diagnosis, and treatment of gastroesophageal reflux in preterm infants. A stepwise approach is advisable for the treatment of gastroesophageal reflux in preterm infants, firstly, promoting nonpharmacological interventions and secondly, limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe gastroesophageal reflux with clinical complications. In the paper entitled “Stretta radiofrequency treatment for GERD: a safe and effective modality,” M. Franciosa et al. focus on the safety, efficacy, and durability of the Stretta radiofrequency treatment for GERD therapy. The novel endoscopic treatment reduces esophageal acid exposure, decreases the frequency of transient lower esophageal relaxation, decreases medication use and improves quality of life in GERD patients. In the paper entitled “Duodenal tube feeding: an alternative approach for effectively promoting weight gain in children with gastroesophageal reflux and congenital heart disease,” S. Kuwata et al. showed that duodenal tube feeding improves the weight gain of infants with gastroesophageal reflux who need treatment for congenital-heart-disease-associated heart failure. In the paper entitled “Changes in ghrelin-related factors in gastroesophageal reflux disease in rats,” M. Nahata et al. examined gastrointestinal hormone profiles and functional changes in rats with GERD. The results suggest that aberrantly increased secretion of peripheral ghrelin and decreased ghrelin responsiveness may occur in GERD rats. In the paper entitled “Surgical management of pediatric gastroesophageal reflux disease,” H. T. Jackson and T. D. Kane review the clinical presentation of GERD in pediatric population and discuss the options for surgical management and outcome in these patients. In the paper entitled “Current advances in the diagnosis and treatment of nonerosive reflux disease,” C. L. Chen and P. I. Hsu, review the literature about the pathogenesis, natural history, diagnosis and treatment of NERD. The authors suggest that a combination of 24-hour esophageal impedance and pH monitoring is indicated to differentiate acid-reflux-related NERD, weakly acid reflux-related NERD (hypersensitive esophagus), nonacid-reflux-related NERD, and functional heartburn in patients with poor response to appropriate PPI treatment. In the paper entitled “Antireflux endoluminal therapies: past and present,” K. C. Yew et al. and S.-K. Chuah review, highlight, and discuss three commonly employed antireflux endoluminal procedures: fundoplication or suturing techniques (EndoCinch, NDO, EsophyX), intramural injection or implant techniques (enhancing LES volume and/or strengthening compliance of the LES-EnteryX, Gatekeeper), and radiofrequency ablation of lower esophageal sphincter and cardia (the Stretta system). Ping-I Hsu Nayoung Kim Khean Lee Goh Deng-Chyang Wu

Dexlansoprazole MR

Background: Proton pump inhibitors (PPIs) have been used for more than two decades to control symptoms of gastroesophageal illnesses. Studies have shown that most PPIs do not provide 24-h symptom control, and that can be the reason for treatment failure. Recently, dexlansoprazole dual delayed release™ (DDR) (Takeda Pharmaceuticals North America, Inc., USA) under the trade name of Kapidex™ (Takeda Pharmaceutical Company Limited, Japan) came onto the market to provide longer duration of action and more effective acid suppression. Objective: The purpose of this paper is to discuss the pharmacology of dexlansoprazole DDR and to provide a concise review of all available studies showing its efficacy. The combination of the slower metabolism of the R-enantiomer and novel dual release pharmacokinetics is impressive. Methods: This manuscript is based on a review of all currently available medical literature on dexlansoprazole DDR. Conclusion: Dexlansoprazole DDR has the potential to outperform traditional PPIs based on the metabolism and novel pharmacokinetics. It is currently FDA approved for the treatment of erosive esophagitis (acute, maintenance) and symptomatic gastroesophageal reflux disease.

Growth factors expression in patients with erosive esophagitis

Although the pathogenesis and treatment of erosive esophagitis (EE) is well recognized, little is known about the cellular and molecular mechanisms of mucosal healing in EE patients. In this pilot study, we enrolled typical EE patients to evaluate what kinds of growth factors and their receptors were activated in their injured esophageal mucosa. Forty endoscopically proved EE patients were consecutively enrolled. Messenger RNA expressions, which includes keratinocyte growth factor (KGF) and its receptor (KGFR), epidermal growth factor (EGF) and its receptor (EGFR), hepatocyte growth factor (HGF) and its receptor (HGFR), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and cyclooxygenase (COX)-1 and COX-2, were measured using real-time polymerase chain reaction (PCR). Data were compared between the injured EE mucosa and their normal esophageal mucosa above EE. The mRNA expressions of HGF, HGFR, EGF, VEGF, and COX-2, but not EGFR, KGF, KGFR, bFGF, and COX-1, were significantly increased in the injured mucosa of EE patients compared with those of normal mucosa (P < 0.05). The study found that HGF, HGFR, EGF, VEGF, and, COX-2 are activated in the injured mucosa of EE patients; their activation might be involved in mucosal repair and ulcer healing of EE.

FDA Approves Nexium for Young Children

In February 2008, the FDA approved the proton-pump inhibitor (PPI) esomeprazole magnesium (Nexium) for short-term treatment of erosive esophagitis and

Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: A meta-analysis

To systematically evaluate the efficacy of H(2)-receptor antagonists (H(2)RAs) and proton pump inhibitors in healing erosive esophagitis (EE). A meta-analysis was performed. A literature search was conducted in PubMed, Medline, Embase, and Cochrane databases to include randomized controlled head-to-head comparative trials evaluating the efficacy of H(2)RAs or proton pump inhibitors in healing EE. Relative risk (RR) and 95% confidence interval (CI) were calculated under a random-effects model. RRs of cumulative healing rates for each comparison at 8 wk were: high dose vs standard dose H(2)RAs, 1.17 (95%CI, 1.02-1.33); standard dose proton pump inhibitors vs standard dose H(2)RAs, 1.59 (95%CI, 1.44-1.75); standard dose other proton pump inhibitors vs standard dose omeprazole, 1.06 (95%CI, 0.98-1.06). Proton pump inhibitors produced consistently greater healing rates than H(2)RAs of all doses across all grades of esophagitis, including patients refractory to H(2)RAs. Healing rates achieved with standard dose omeprazole were similar to those with other proton pump inhibitors in all grades of esophagitis. H(2)RAs are less effective for treating patients with erosive esophagitis, especially in those with severe forms of esophagitis. Standard dose proton pump inhibitors are significantly more effective than H(2)RAs in healing esophagitis of all grades. Proton pump inhibitors given at the recommended dose are equally effective for healing esophagitis.

Discussion 2

Discussion 2