Vonoprazan in erosive esophagitis: Influence of gender and hiatus hernia on outcomes

Abstract

Objective: This study aims to determine the efficacy of vonoprazan in erosive esophagitis and association of gender and hiatus hernia with treatment outcomes.

Methodology: This prospective single arm cohort study (before and after treatment) was conducted from 1^st January to 31st August 2025 in Department of Gastroenterology, HMC Peshawar. Non-probability convenience sampling technique was used. Total 220 patients with endoscopicaly confirmed erosive esophagitis (EE) and fulfilling inclusion criteria were included. Exclusion criteria included peptic ulcer disease, malignancy, prior gastrointestinal surgery, pregnancy and recent NSAID use. All patients received vonoprazan 20 mg once daily for 8 weeks. Demographic and clinical data were documented. Endoscopic evaluation was repeated post-treatment. Data was analyzed using descriptive statistics, with p < 0.05 considered statistically significant.

Results: The mean age was 42.51±8.19 years, with 120 (54.5%) male and 100 (45.5%) female. Before treatment, 115(52.3%) had LA-C and 26(11.8%) had LA-D esophagitis. Following treatment, 191(86.8%) out of 220 patients had no esophagitis, 18(8.2%) had LA-A and 11(5%) had LA-B esophagitis (OR:6.59, 95%CI 4.45 - 9.73, p < 0.001). Complete healing rates were similar in male and female patients (p = 0.94). Among 58 patients having hiatus hernia, 35(60.34%) had no esophagitis post-treatment as compared to those without hernia where 156 out of 162 (96.29%) had no esophagitis post-treatment (OR:17.08, CI (6.47- 45.08), p < 0.001).

Conclusion: Vonoprazan demonstrated high efficacy in healing erosive esophagitis, especially in patients without hiatus hernia while having similar efficacy in both genders. These findings highlight vonoprazan’s therapeutic potential in management of erosive esophagitis.