Therapeutic Advances in Gastroenterology最新文献

{"title":"Direct and indirect effects of pathogenic bacteria on the integrity of intestinal barrier.","authors":"Lin-Zhen Shu, Yi-Dan Ding, Qing-Ming Xue, Wei Cai, Huan Deng","doi":"10.1177/17562848231176427","DOIUrl":"10.1177/17562848231176427","url":null,"abstract":"<p><p>Bacterial translocation is a pathological process involving migration of pathogenic bacteria across the intestinal barrier to enter the systemic circulation and gain access to distant organs. This phenomenon has been linked to a diverse range of diseases including inflammatory bowel disease, pancreatitis, and cancer. The intestinal barrier is an innate structure that maintains intestinal homeostasis. Pathogenic infections and dysbiosis can disrupt the integrity of the intestinal barrier, increasing its permeability, and thereby facilitating pathogen translocation. As translocation represents an essential step in pathogenesis, a clear understanding of how barrier integrity is disrupted and how this disruption facilitates bacterial translocation could identify new routes to effective prophylaxis and therapy. In this comprehensive review, we provide an in-depth analysis of bacterial translocation and intestinal barrier function. We discuss currently understood mechanisms of bacterial-enterocyte interactions, with a focus on tight junctions and endocytosis. We also discuss the emerging concept of bidirectional communication between the intestinal microbiota and other body systems. The intestinal tract has established 'axes' with various organs. Among our regulatory systems, the nervous, immune, and endocrine systems have been shown to play pivotal roles in barrier regulation. A mechanistic understanding of intestinal barrier regulation is crucial for the development of personalized management strategies for patients with bacterial translocation-related disorders. Advancing our knowledge of barrier regulation will pave the way for future research in this field and novel clinical intervention strategies.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231176427"},"PeriodicalIF":4.2,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5e/71/10.1177_17562848231176427.PMC10233627.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of molecular testing in pancreatic cancer.","authors":"David B Zhen, Rachael A Safyan, Eric Q Konick, Ryan Nguyen, Colin C Prichard, E Gabriela Chiorean","doi":"10.1177/17562848231171456","DOIUrl":"10.1177/17562848231171456","url":null,"abstract":"<p><p>Pancreatic ductal adenocarcinoma (PDA) is highly aggressive and has few treatment options. To personalize therapy, it is critical to delineate molecular subtypes and understand inter- and intra-tumoral heterogeneity. Germline testing for hereditary genetic abnormalities is recommended for all patients with PDA and somatic molecular testing is recommended for all patients with locally advanced or metastatic disease. <i>KRAS</i> mutations are present in 90% of PDA, while 10% are <i>KRAS</i> wild type and are potentially targetable with epidermal growth factor receptor blockade. KRAS^G12C inhibitors have shown activity in G12C-mutated cancers, and novel G12D and pan-RAS inhibitors are in clinical trials. DNA damage repair abnormalities, germline or somatic, occur in 5-10% of patients and are likely to benefit from DNA damaging agents and maintenance therapy with poly-ADP ribose polymerase inhibitors. Fewer than 1% of PDA harbor microsatellite instability high status and are susceptible to immune checkpoint blockade. Albeit very rare, occurring in <1% of patients with <i>KRAS</i> wild-type PDAs, <i>BRAF V600E</i> mutations, <i>RET</i> and <i>NTRK</i> fusions are targetable with cancer agnostic Food and Drug Administration-approved therapies. Genetic, epigenetic, and tumor microenvironment targets continue to be identified at an unprecedented pace, enabling PDA patients to be matched to targeted and immune therapeutics, including antibody-drug conjugates, and genetically engineered chimeric antigen receptor or T-cell receptor - T-cell therapies. In this review, we highlight clinically relevant molecular alterations and focus on targeted strategies that can improve patient outcomes through precision medicine.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231171456"},"PeriodicalIF":4.2,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c5/35/10.1177_17562848231171456.PMC10184226.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10662728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue therapy for refractory <i>Helicobacter pylori</i> infection: current status and future concepts.","authors":"Song-Wei Wang, Fang-Jung Yu, Fu-Chen Kuo, Jiunn-Wei Wang, Yao-Kuang Wang, Yi-Hsun Chen, Wen-Hung Hsu, Chung-Jung Liu, Deng-Chyang Wu, Chao-Hung Kuo","doi":"10.1177/17562848231170941","DOIUrl":"10.1177/17562848231170941","url":null,"abstract":"<p><p><i>Helicobacter pylori</i> infection is an important issue worldwide, and several guidelines have been published for clinicians to achieve successful eradication. However, there are still some patients who remain infected with <i>H. pylori</i> after treatment. Clinicians should identify the reasons that caused treatment failure and find strategies to manage them. We have searched and organized the literature and developed methods to overcome factors that contribute to prior treatment failure, such as poor compliance, inadequate intragastric acid suppression, and antibiotic resistance. To improve compliance, telemedicine or smartphone applications might play a role in the modern world by increasing doctor-patient relationships, while concomitant probiotics could be administered to reduce adverse effects and enhance adherence. For better acid suppression, high-potency and high-dose proton-pump inhibitors or potassium-competitive acid blockers have preferable efficacy. To overcome antibiotic resistance, susceptibility tests either by culture or by genotyping are the most commonly used methods and have been suggested for antibiotic selection before rescue therapy, but empirical therapy according to detailed medical history could be an alternative. Eradication with a longer treatment period (14 days) has a better outcome than shorter period (7 or 10 days). Ultimately, clinicians should select antibiotics based on the patient's history of drug allergy, previous antibiotic exposure, local antibiotic resistance, available medications, and cost. In addition, identifying patients with a high risk of cancer and shared decision-making are also essential for those who have experienced eradication failure.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231170941"},"PeriodicalIF":4.2,"publicationDate":"2023-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/59/10.1177_17562848231170941.PMC10164852.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10300607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of immune checkpoint inhibitors in biliary tract cancer with KRAS mutation.","authors":"Sun Young Jeong, Jung Yong Hong, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Jae Yeon Jang, Youngkyung Jeon, Seung Tae Kim","doi":"10.1177/17562848231170484","DOIUrl":"10.1177/17562848231170484","url":null,"abstract":"<p><strong>Background: </strong>With a 15% incidence, KRAS is one of the most common mutations in biliary tract cancer (BTC) and is a poor prognostic factor. Immune checkpoint inhibitors (ICIs) as salvage therapy have modest activity in BTC.</p><p><strong>Objectives: </strong>There are limited data on the efficacy of ICIs according to KRAS mutation in BTC. We evaluated the efficacy of ICIs in BTC patients with or without KRAS mutations.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>We conducted molecular profiling in BTC patients who received ICIs as salvage therapy. The expression of programmed death ligand 1 (PD-L1) on tumor cells was assessed using immunohistochemistry. The TruSight^TM Oncology 500 assay from Illumina was used as a cancer panel. We analyzed overall survival (OS) and progression-free survival (PFS) of ICI in BTC patients according to KRAS mutation and PD-L1 expression.</p><p><strong>Results: </strong>A total of 62 patients were included in this analysis. The median age was 68.0 years; 47 patients (75.8%) received pembrolizumab and 15 (24.2%) received nivolumab as salvage therapy. All patients received gemcitabine plus cisplatin as the frontline therapy, and 53.2% received fluoropyrimidine plus oxaliplatin (FOLFOX) before ICI. The median number of lines of prior chemotherapy was 2.5. The KRAS mutation was found in 13 patients (19.1%), and 28 patients (45.2%) showed 1% or more of tumor cells out of visible tumor cells positive for PD-L1. There was no statistical correlation between KRAS mutation and PD-L1 expression. The median OS and PFS with ICI were 5.6 [interquartile range (IQR): 3.3-8.0] and 3.8 (IQR: 3.0-4.5) months, respectively. There were no statistically significant differences in PFS with ICIs according to KRAS mutation (mutant type <i>versus</i> wild type) and PD-L1 expression (positive <i>versus</i> negative). In subgroup analysis, patients with both KRAS mutation and PD-L1 positivity had longer PFS compared with patients with KRAS mutation and PD-L1 negativity (10.1 <i>versus</i> 2.6 months, <i>p</i> = 0.047). This finding was not shown in patients with wild-type KRAS.</p><p><strong>Conclusion: </strong>Our analysis suggested that PD-L1 expression might be a useful biomarker for ICIs in BTC patients with KRAS mutation but not in those with wild-type KRAS.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231170484"},"PeriodicalIF":4.2,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/96/10.1177_17562848231170484.PMC10164250.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to optimizing inflammatory bowel disease care in the United States.","authors":"Elizabeth A Spencer, Sadeea Abbasi, Maia Kayal","doi":"10.1177/17562848231169652","DOIUrl":"10.1177/17562848231169652","url":null,"abstract":"<p><p>Significant progress in the management and modification of inflammatory bowel disease (IBD) has been made; however, significant barriers to the optimization of IBD care in the United States still exist. The majority of these barriers are constructed by insurance carriers and the integration of market pressures into healthcare decision-making. In this review, we highlight the barriers to IBD care optimization within the context of the US insurance system and review current and proposed solutions.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231169652"},"PeriodicalIF":3.4,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/20/45/10.1177_17562848231169652.PMC10164253.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9498263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world outcomes associated with vonoprazan-based <i>versus</i> proton pump inhibitor-based therapy for <i>Helicobacter pylori</i> infection in Japan.","authors":"Colin W Howden, Erin E Cook, Elyse Swallow, Karen Yang, Helen Guo, Corey Pelletier, Rinu Jacob, Kentaro Sugano","doi":"10.1177/17562848231168714","DOIUrl":"10.1177/17562848231168714","url":null,"abstract":"<p><strong>Background: </strong>Japanese guidelines recommend triple therapy with vonoprazan or a proton pump inhibitor (PPI) in combination with antibiotics to treat <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection. While studies have shown improved eradication rates and reduced costs with vonoprazan <i>versus</i> PPIs, there is little data describing healthcare resource use (HCRU) and treatment patterns.</p><p><strong>Objectives: </strong>To compare patients treated with a vonoprazan-based or PPI-based regimen for <i>H. pylori</i> infection in Japan in terms of their characteristics, HCRU, healthcare costs, clinical outcomes, and treatment patterns.</p><p><strong>Design: </strong>Retrospective matched cohort.</p><p><strong>Methods: </strong>We used data from the Japan Medical Data Center claims database (July 2014-January 2020) to identify adult patients with <i>H. pylori</i> infection and a first observed use of vonoprazan or a PPI in 2015 or later (index date). Patients prescribed a vonoprazan-based or a PPI-based regimen were matched 1:1 using propensity score matching. HCRU, healthcare costs, diagnostic tests, a proxy for <i>H. pylori</i> eradication (i.e. no triple therapy with amoxicillin in combination with metronidazole or clarithromycin >30 days after the index date), and second-line treatment were described during the 12-month follow-up period.</p><p><strong>Results: </strong>Among 25,389 matched pairs, vonoprazan-treated patients had fewer all-cause and <i>H. pylori-</i>related inpatient stays and outpatient visits than PPI-treated patients, resulting in lower all-cause healthcare costs [185,378 Japanese yen (JPY) <i>versus</i> 230,876 JPY, <i>p</i> < 0.001]. Over 80% of patients received a post-treatment test for <i>H. pylori</i>. Fewer vonoprazan-treated than PPI-treated patients subsequently received an additional triple regimen for <i>H. pylori</i> infection (7.1% <i>versus</i> 20.0%, <i>p</i> < 0.001) or a prescription for vonoprazan or a PPI as monotherapy (12.4% <i>versus</i> 26.4%, <i>p</i> < 0.001) between 31 days and 12 months after the index date.</p><p><strong>Conclusion: </strong>Patients with <i>H. pylori</i> infection who were treated with vonoprazan-based therapy had lower rates of subsequent <i>H. pylori</i> treatment, lower overall and <i>H. pylori</i>-related HCRU, and lower healthcare costs than patients treated with PPI-based therapy.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231168714"},"PeriodicalIF":4.2,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/92/10.1177_17562848231168714.PMC10161293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10289661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic eradication choices in <i>Helicobacter pylori</i> infection in children.","authors":"Marco Manfredi, Giancarlo Gargano, Pierpacifico Gismondi, Bernardino Ferrari, Silvia Iuliano","doi":"10.1177/17562848231170052","DOIUrl":"10.1177/17562848231170052","url":null,"abstract":"<p><p>Current recommendations on <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication in children differ from adults. In <i>H. pylori</i>-infected adults, the eradication is always recommended because of the risk to develop gastrointestinal and non-gastrointestinal associated diseases. Instead, before treating infected children, we should consider all the possible causes and not merely focus on <i>H. pylori</i> infection. Indeed, pediatric international guidelines do not recommend the <i>test and treat strategy</i> in children. Therefore, gastroscopy with antimicrobial susceptibility testing by culture on gastric biopsies should be performed before starting the eradication therapy in children to better evaluate all the possible causes of the symptomatology and to increase the eradication rate. Whether antibiotic susceptibility testing is not available, gastroscopy is anyway recommended to better set any possible cause of symptoms and not simply focus on the presence of <i>H. pylori</i>. In children the lower antibiotics availability compared to adults forces to treat based on antimicrobial susceptibility testing to minimize the unsuccessful rates. The main antibiotics used in children are amoxicillin, clarithromycin, and metronidazole in various combinations. In empirical treatment, triple therapy for 14 days based either on local antimicrobial susceptibility or on personal antibiotic history is generally recommended. Triple therapy with high dose of amoxicillin is a valid alternative choice, either in double resistance or in second-line treatment. Moving from therapeutic regimens used in adults, we could also select quadruple therapy with or without bismuth salts. However, all the treatment regimens often entail unpleasant side effects and lower compliance in children. In this review, the alternative and not yet commonly used therapeutic choices in children were also analyzed.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231170052"},"PeriodicalIF":4.2,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d9/a0/10.1177_17562848231170052.PMC10141265.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9386574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and celiac disease: a review.","authors":"Brandon S Cohen, Benjamin Lebwohl","doi":"10.1177/17562848231170944","DOIUrl":"10.1177/17562848231170944","url":null,"abstract":"<p><p>The aim of this review is to broadly cover how the COVID-19 pandemic has affected individuals with celiac disease, including perceived risk, risk of contraction or severe infection, considerations regarding vaccination, access to gluten-free food during the pandemic, and possible long-term changes to the practice of celiac disease management spurred by the pandemic. While initially there was increased perceived risk about COVID-19 in the celiac disease population, studies have found that individuals with celiac disease are not at an increased risk of contracting or having a severe course compared to the general population. There is not yet evidence that COVID-19 infection will lead to an increase in celiac disease incidence, though more research on this topic with longer-term follow-up is necessary to make this determination. Limited access to in-person visits led to an increase in telemedicine, which was adopted swiftly by this patient population and may offer improved access in the long term. In summary, individuals with celiac disease do not appear to be at an increased risk of contracting COVID-19 or having a more severe disease course.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231170944"},"PeriodicalIF":4.2,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/13/10.1177_17562848231170944.PMC10133858.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9392938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IBD barriers across the continents: a continent-specific analysis: Latin America.","authors":"Natália Sousa Freitas Queiroz, Camilla de Almeida Martins, Abel Botelho Quaresma, Pablo A Olivera Sendra, Kenneth Ernest-Suarez, Paulo Gustavo Kotze","doi":"10.1177/17562848231167953","DOIUrl":"10.1177/17562848231167953","url":null,"abstract":"<p><p>Latin America (LATAM) is a large region comprising 47 countries and territories. Each one carries a different cultural and historical background, diverse political systems, and a particular approach to healthcare management. There is a lack of high-quality data on the epidemiology of inflammatory bowel diseases (IBD) in this region, including broad and detailed information about the penetration of biological and advanced therapies as treatment strategies. From an IBD perspective, patients experience, in general, fragmentations and inequities in the healthcare systems, with different and usually delayed access to qualified health services. This review explores the barriers to accessing IBD care throughout LATAM. The authors compiled data from multiple sources, such as studies focusing on epidemiology, biological penetration, and surgical rates. In addition, overall access to IBD treatments was assessed through a questionnaire distributed to physicians in LATAM via email and direct messaging to capture local perspectives.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231167953"},"PeriodicalIF":3.4,"publicationDate":"2023-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/8f/10.1177_17562848231167953.PMC10134129.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and type of adverse events in patients taking vonoprazan: A systematic review and meta-analysis.","authors":"Wentao Xu, Zhaohui Bai, Yiyang Shang, Jing Wang, Yujun Wong, Xingshun Qi","doi":"10.1177/17562848231167858","DOIUrl":"10.1177/17562848231167858","url":null,"abstract":"<p><strong>Background: </strong>Vonoprazan, a novel acid-suppressive drug, is non-inferior to proton pump inhibitors (PPIs) for the management of gastric acid-related diseases. However, the safety of vonoprazan has not been systematically evaluated yet.</p><p><strong>Objectives: </strong>To elucidate the incidence and type of adverse events (AEs) in patients taking vonoprazan.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources and methods: </strong>PubMed, EMBASE, and Cochrane Library databases were searched for all studies reporting the safety of vonoprazan. The incidences of any AEs, drug-related AEs, serious AEs, AEs leading to drug discontinuation, and common AEs were pooled. Odds ratios (ORs) were calculated to compare the incidence of AEs between patients taking vonoprazan and PPIs.</p><p><strong>Results: </strong>Seventy-seven studies were included. The pooled incidences of any AEs, drug-related AEs, serious AEs, and AEs leading to drug discontinuation were 20, 7, 1, and 1%, respectively. The incidences of any AEs (OR = 0.96, <i>p</i> = 0.66), drug-related AEs (OR = 1.10, <i>p</i> = 0.44), serious AEs (OR = 1.14, <i>p</i> = 0.36), and AEs leading to drug discontinuation (OR = 1.09, <i>p</i> = 0.55) were not significantly different between patients taking vonoprazan and PPIs. In subgroup analyses, patients with peptic ulcer disease (PUD) had higher incidences of any AEs, serious AEs, and AEs leading to drug discontinuation than those with gastroesophageal reflux disease (GERD), <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection, and artificial ulcer after gastric endoscopic submucosal dissection (ESD), but patients with <i>H. pylori</i> infection had a higher incidence of drug-related AEs than those with PUD, GERD, and artificial ulcer after gastric ESD. The incidence of AEs was higher in patients taking long-term use of vonoprazan than those taking short-term use of vonoprazan.</p><p><strong>Conclusion: </strong>Vonoprazan is well tolerated and shows similar safety compared to PPIs. The safety of vonoprazan may be primarily influenced by its indications and duration.</p><p><strong>Registration: </strong>PROSPERO CRD42022314982.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231167858"},"PeriodicalIF":4.2,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/8b/10.1177_17562848231167858.PMC10126681.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9718427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}