Step-Down Therapy Using Vonoprazan for Giant Gastric Polyps in Long-Term Proton Pump Inhibitor Administration.

Introduction: Gastroesophageal reflux disease (GERD) is diagnosed based on bothersome symptoms, such as heartburn, and the presence of mucosal breaks endoscopically. Treatments that suppress gastric acid, such as proton pump inhibitor (PPI) and vonoprazan, are frequently administered. Several studies reported regarding the safety and side effects of long-term PPI administration, including an association with gastric polyps. We report a case of maintained symptom resolution and significantly shrank gastric polyps by performing step-down therapy, which is minimal acid-suppressing treatment.

Case presentation: A female patient in her 60s had been taking PPI for reflux esophagitis for >10 years. An upper gastrointestinal endoscopy revealed two gastric polyps measuring 20 mm and 10 mm. She was referred to our hospital for resection, but narrow-band imaging revealed a nonneoplastic lesion. PPI was discontinued, and step-down therapy using vonoprazan was performed. During the treatment, a lifestyle guidance app (Muneyake PRO) was used to record daily heartburn symptoms, oral medication status, and daily life status. She was worried that her symptoms would worsen due to discontinuation, but she gained her understanding when the use of the app to monitor her symptoms was explained. The app was useful for understanding the progress of symptoms and the status of oral medication. Step-down therapy was performed only twice after PPI discontinuation, symptoms have not worsened, and follow-up endoscopy revealed significant gastric polyp shrinkage.

Conclusion: We experienced a case in which minimal acid-suppression treatment and step-down therapy using vonoprazan resulted in GERD symptom control and significant gastric polyp shrinkage.