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( Tatsuhiro Masaoka ),( Hisako Kameyama ),( Tsuyoshi Yamane ),( Yuta Yamamoto ),( Hiroya Takeuchi ),( Hidekazu Suzuki ),( Yuko Kitagawa ),( Takanori Kanai ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2018 Journal of Neurogastroenterology and Motility (JNM Vol.24 No.4
Background/Aims Potassium-competitive acid blockers are expected to be the next generation of drugs for the treatment of diseases caused by gastric acid. In 2015, vonoprazan fumarate, a novel potassium-competitive acid blocker, was approved by the Japanese health insurance system. Since its approval, patients refractory to vonoprazan can be encountered in clinical settings. We designed this study to clarify the pathophysiology of gastroesophageal reflux disease refractory to vonoprazan. Methods In this retrospective study, we involved patients who had refractory symptoms after administration of standard-dose proton pump inhibitors or vonoprazan and underwent diagnostic testing with esophageal high-resolution manometry and 24-hour multichannel intraluminal impedance and pH monitoring while using proton pump inhibitors or vonoprazan. Patients were diagnosed based on the Rome IV criteria for functional gastrointestinal disorders and diagnostic test results. Results Twenty-seven patients were analyzed during this study. Gastric pH ≥ 4 was sustained for a longer period of time, and the esophageal acid exposure time and number of acid reflux events were shorter in the vonoprazan group than in the proton pump inhibitor group. The percentage of patients diagnosed with acidic gastroesophageal reflux disease in the vonoprazan group was lower than that in the proton pump inhibitor group. Conclusions Intra-gastric pH and acid reflux were strongly suppressed by 20-mg vonoprazan. When patients with gastroesophageal reflux disease present symptoms after administration of 20-mg vonoprazan, the possibility of pathophysiologies other than acid reflux should be considered. (J Neurogastroenterol Motil 2018;24:577-583)
Yoshifumi Takahashi,Hiroyuki Fujiwara,Kouji Yamamoto,Masashi Takano,Morikazu Miyamoto,Kosei Hasegawa,Maiko Miwa,Toyomi Satoh,Hiroya Itagaki,Takashi Hirakawa,Mayuyo Mori-Uchino,Tomonori Nagai,Yoshinobu 대한부인종양학회 2024 Journal of Gynecologic Oncology Vol.35 No.4
Objective: In Japan, perioperative prophylaxis of pulmonar y embolism (PE) in gynecologiccancer patients with preoperative asymptomatic venous thromboembolism (VTE) has notbeen well established yet. The GOTIC-VTE trial was a prospective, multi-center, single-armclinical trial to investigate the prevention of postoperative symptomatic PE onset by seamlessanticoagulant therapy from the preoperative period to 4 weeks after surger y instead of usingintermittent pneumatic compression. Methods: Anticoagulant therapy was started immediately after asymptomatic VTE diagnosisand stopped preoperatively according to the rules of each institution. Unfractionatedheparin administration was resumed within 12 hours postoperatively, and this was followedby the switch to low-molecular-weight heparin and subsequently, edoxaban; this cycle wascontinued for 28 days. Primar y outcome was the occurrence of symptomatic PE in 28 dayspostoperatively. Secondar y outcomes were the incidence of VTE-related events in 28 days and6 months postoperatively and protocol-related adverse events. Results: Between Februar y 2018 and September 2020, 99 patients were enrolled; of these, 82 patients were assessed as the full analysis set, including 58 for ovarian cancer, fallopian tube,or peritoneal cancer; 21 for endometrial cancer; and 3 for cer vical cancer. No symptomatic PEwas obser ved within 28 days postoperatively; two patients had bleeding events (major bleedingand clinically relevant nonmajor bleeding) and three had grade 3 adverse events (increasedalanine transaminase, aspartate aminotransferase, or gamma-glutamyl transferase). Conclusion: The multifaceted perioperative management for gynecologic malignancies withasymptomatic VTE effectively prevented postoperative symptomatic PE. Trial Registration: JRCT Identifier: jRCTs031180124