Efficacy of Vonoprazan vs. Intravenous Proton Pump Inhibitor in Prevention of Re-Bleeding
of High-Risk Peptic Ulcers: A Randomized Controlled Pilot Study
Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness
in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis.
Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding
4, comparable to PPIs. This study aims to evaluate the comparative efficacy of intravenous
PPI infusion versus VPZ in preventing re-bleeding after endoscopic hemostasis in patients
with high-risk peptic ulcers. Methods: A randomized, double-blind, controlled, and
double-dummy design was employed. Patients with peptic ulcer bleeding (Forrest class
IA/IB or IIA/IIB) who underwent endoscopic hemostasis were randomly assigned to either
the PPI group or the VPZ group. Re-bleeding rates at 3, 7, and 30 days, the number
of blood transfusions required, length of hospitalization, and ulcer healing rate
at 56 days were assessed. Results: A total of 44 eligible patients were enrolled,
including 20 patients (PPI group, n = 11; VPZ group, n = 9) with high-risk peptic
ulcers. The mean age was 66 years, with 70% being male. Re-bleeding within 72 h occurred
in 9.1% of the PPI group versus 0% in the VPZ group (p = 1.000). There was no significant
difference in re-bleeding rates within 7 days and 30 days (18.2% vs. 11.1%, p = 1.000).
Additionally, the ulcer healing rate did not significantly differ between the groups
(87.5% vs. 77.8%). Conclusions: This pilot study demonstrates comparable efficacy
between oral vonoprazan and continuous PPI infusion in preventing recurrent bleeding
events among high-risk peptic ulcer patients following successful endoscopic hemostasis.