DDSEP® 8 Quick Quiz

Question 1

Publish date: February 28, 2023

Q1. A 62-year-old woman with rheumatoid arthritis reports regurgitation, heartburn, and dysphagia. She undergoes upper endoscopy, which reveals a 3-cm hiatal hernia and Los Angeles (LA) Grade D esophagitis. Previously performed esophageal function tests revealed absent contractility and a total acid exposure time of 8.2%. Her thoracic surgeon is concerned about the postoperative risks of dysphagia with hernia repair; therefore, surgery is deferred. Although improved, she continues to have symptoms of heartburn with daily lansoprazole.

Which of the following is likely to provide the best chance at symptom improvement?

Adding calcium carbonate (antacid) to her current regimen

Switching lansoprazole to vonoprazan

Using antireflux precautions including sleeping on two pillows

Avoiding eating spicy foods

Q1. Correct answer: B - Adding calcium carbonate (antacid) to her current regimen

Rationale

Compared with proton pump inhibitors (PPIs), vonoprazan is a potassium-competitive acid blocker (PCAB), which inhibits acid secretion by competitively blocking availability of potassium to hydrogen-potassium ATPase. Vonoprazan is rapidly absorbed independent of eating and is not affected by CYP2C19 polymorphisms. Several studies have compared PPIs with vonoprazan. Although vonoprazan is highly effective for treating LA Grade A and B esophagitis, so is lansoprazole, and healing rates at 8 weeks are 100% versus 99.2%, respectively. In contrast, vonoprazan healing of LA Grade C and D esophagitis at 8 weeks is 98.7% compared with 87.5% for lansoprazole.
Sleeping on pillows is not a reliable way to reduce reflux, as patients often move during sleep and lose any benefit from being propped on them. Antacids would not provide superior acid inhibition, compared with vonoprazan, and avoiding spicy foods would not address the underlying permissive reflux barrier that exists (hiatal hernia).

Reference

Graham DY and Dore MP. Update on the Use of Vonoprazan: A Competitive Acid Blocker. Gastroenterology. 2018;154(3):462-6. doi: 10.1053/j.gastro.2018.01.018.

Next Article:

Recruiting gastroenterology and hepatology fellows virtually - Should we continue after the pandemic?