Voquezna (vonoprazan) / Takeda, Otsuka, Phathom Pharma - LARVOL DELTA

Early-Onset Gastroesophageal Junction Adenocarcinoma in a 27-year-old Female: A Rising Trend (ACG 2026) - "Recommendations included scheduling an esophageogastroduodenoscopy (EGD), starting vonoprazan, providing ondansetron as needed for nausea, ordering a CT scan to rule out differential diagnoses, along with blood work. This further emphasizes the importance of maintaining clinical awareness of this malignancy even in patients who fall outside the traditional demographic profile associated with this disease. Figure: Coronal CT Abdomen and Pelvis Demonstrating Gastroesophageal Junction Mass Figure: Esophagogastroduodenoscopy Image Showing Large Fungating, Ulcerated, Near-Obstructing Gastroesophageal Junction Mass"

Dyspepsia • Epstein-Barr Virus Infections • Gastroenterology • Gastroesophageal Junction Adenocarcinoma • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Infectious Disease • Oncology • Peptic Ulcer • Polyendocrine Metabolic Ovarian Syndrome • Solid Tumor • BRCA2 • HRD • MRE11A • PMS1 • PPM1D • TP53

Potassium-Competitive Acid Blockers Were Associated With Lower Major Adverse Safety Events Compared With Proton Pump Inhibitors: A Propensity-Matched Cohort Study (ACG 2026) - " We conducted a retrospective cohort study using the TriNetX database to identify adult patients treated with either vonoprazan or PPIs... A total of 16,337 patients were included in each cohort after matching. Baseline characteristics were well balanced after matching, with a mean age of 56.3 ± 16.0 years and 66.8% females. Compared with PPIs, PCABs were associated with lower risks of AKI (aHR 0.46, 95% CI 0.40â0.52; <0.001), acute interstitial nephritis (aHR 0.48, 95%CI 0.33â0.69; p< 0.001), pneumonia (aHR 0.63, 95%CI 0.54â0.72; p< 0.001), and hypomagnesemia (aHR 0.54, 95%CI 0.46â0.62; p< 0.001) [Figure 1]."

Adverse events • Clinical • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Infectious Disease • Nephrology • Pneumonia • Respiratory Diseases

Efficacy and Safety of Modern Salvage Therapies After Multiple Helicobacter pylori Eradication Failures: A Systematic Review and Meta-Analysis (ACG 2026) - "While several rescue strategies have emerged, including vonoprazan-amoxicillin dual therapy and rifabutin-based regimens. Of 1,605 identified records, 21 studies met the inclusion criteria. Twelve studies reported intention-to-treat (ITT) eradication outcomes involving 1,746 patients, while five studies reported modified intention-to-treat (mITT) outcomes involving 1,165 patients. ITT analysis demonstrated no significant difference in eradication rates between modern and conventional rescue regimens (OR 1.14, 95% CI 0.87â1.48; p=0.34; I²=63.1%)."

Retrospective data • Review • Infectious Disease

Efficacy and Safety of Vonoprazan-Amoxicillin Dual vs Bismuth Quadruple Therapy for First-Line H. pylori Eradication in Treatment-Naïve Adults: Updated Systematic Review and Meta-Analysis (ACG 2026) - "We included 17 RCTs with 4,497 patients. VA-dual significantly improved eradication rates compared to BQT (RR 1.04; 95% CI 1.01â1.07; P = 0.01). VA-dual therapy was associated with significantly higher compliance compared with BQT (RR 1.02; 95% CI 1.00â1.03; P = 0.08)."

Retrospective data • Review • Constipation • Extranodal Marginal Zone Lymphoma • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Hematological Malignancies • Infectious Disease • Lymphoma • Marginal Zone Lymphoma • Peptic Ulcer • Solid Tumor

Oral Vonoprazan Versus High-Dose Intravenous PPIs After Endoscopic Hemostasis for High-Risk Peptic Ulcer Bleeding: A Systematic Review and Meta-analysis (ACG 2026) - "Two randomized controlled trials (n=214) were included. Compared with high-dose intravenous PPIs , oral vonoprazan showed no significant difference in recurrent bleeding at 72 hours (RR 0.47, 95% CI 0.14â1.64), 7 days (RR 0.61, 95% CI 0.23â1.62), or 30 days (RR 0.67, 95% CI 0.29â1.58), with no observed heterogeneity. No significant differences were observed in mortality, surgery, or repeat interventions."

Retrospective data • Review • Gastroenterology • Peptic Ulcer

Gastroesophageal Intussusception After Peroral Endoscopic Myotomy for Achalasia in an Adult: Case Report and Literature Review (ACG 2026) - "His symptoms had previously been controlled with vonoprazan but recurred after transitioning to rabeprazole. Figure: EGD showing severe distal esophagitis and respiratory-dependent gastroesophageal intussusception. Figure: Computed tomography of the abdomen and pelvis shows a small hiatal hernia and distal esophageal dilation (green arrow) but no evidence of gastroesophageal intussusception."

Case report • Clinical • Review • Cardiovascular • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Immunology • Inflammatory Arthritis • Lupus • Rare Diseases

Effectiveness of Vonoprazan in Gastroesophageal Reflux Disease Patients With Anxiety and/or Depression in China: Post Hoc Analysis of the VIEW Study (ACG 2026) - P=N/A | "A total of 833 patients with GERD and comorbid anxiety and/or depression were included in the effectiveness analysis. Symptom relief improved progressively over the first two weeks, with symptomâfree rates for allâday, daytime, and nighttime heartburn reaching 44.2%â53.6% and for regurgitation reaching 35.0%â46.4% by Week 2 ( Fig.1 ). At Week 4, the total mean (SD) GerdQ score decreased from 8.9 (2.79) at baseline to 7.1 (2.10), corresponding to a mean change of â1.8 (2.94)."

Clinical • Retrospective data • CNS Disorders • Depression • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Mood Disorders • Psychiatry • Sleep Disorder

Longitudinal Gut Resistome Remodeling and Phenotype-Specific Refractory GERD Outcomes During P-CAB Versus PPI Therapy: Prospective Multicenter Data from India (ACG 2026) - "A total of 1,300 patients were enrolled, including 783 males (60.2%) and 517 females (39.8%). Patients received either vonoprazan-based P-CAB therapy (20 mg daily; n=650) or esomeprazole/rabeprazole-based PPI therapy (40 mg daily; n=650). Mean age was 44.6±11.8 years (95% CI 43.9â45.2)."

Clinical • Gastroenterology • Gastroesophageal Reflux Disease • Immunology

Simplified Vonoprazan Rescue Regimens for Persistent/Refractory Helicobacter pylori : A Rescue-Specific Meta-Analysis of Randomized Trials (ACG 2026) - "Additional prespecified comparisons were supported by only one eligible RCT each and were summarized without pooling: vonoprazan-amoxicillin had fewer adverse reactions than susceptibility-guided therapy (RR 0.29, 95% CI 0.16-0.54), adding Saccharomyces boulardii improved ITT eradication versus vonoprazan-amoxicillin alone (RR 1.16, 95% CI 1.03-1.30), and rifabutin-based vonoprazan triple therapy achieved comparable ITT eradication to quadruple therapy (RR 0.99, 95% CI 0.91-1.08). Six rescue-relevant RCTs were eligible; 3 RCTs (n=1,278) formed the main meta-analysis (vonoprazan-amoxicillin in 2 trials; vonoprazan-tetracycline in 1 trial). Dual therapy did not show a clear intention-to-treat (ITT) eradication advantage versus quadruple therapy (RR 0.94, 95% CI 0.85-1.05; I²=74.3%). Modified ITT (RR 0.93, 95% CI 0.84-1.04; I²=82.2%) and per-protocol analyses (RR 0.93, 95% CI 0.85-1.02; I²=76.3%) were concordant."

Retrospective data • Infectious Disease

Endoscopic Sleeve Gastroplasty Worsens Gastroesophageal Reflux Disease Compared to GLP-1 Agonists and Roux-en-Y Gastric Bypass: Results From a Large Population-based Database (ACG 2026) - "Outcomes included de novo GERD, worsening GERD (new Vonoprazan use, esophagitis, esophageal ulcer, fundoplication), new PPI/H2 antagonist use, Barrettâs esophagus (BE) and esophageal cancer (EC)... The ESG (N=732), GLP1-RA (N=779,856), and RYGB cohorts (27,679) were predominantly female and Caucasian, with mean ages of 56.3±14.1, 53.7±13.4, and 44.1±11.6 years, respectively. Table 1 summarizes the baseline characteristics before and after PSM. After PSM, there were 726 and 653 patients in each arm for ESG vs GLP1-RA and ESG vs RYGB, respectively."

Bariatric surgery • Clinical • Barrett Esophagus • Esophageal Cancer • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Genetic Disorders • Obesity

Efficacy and Safety of Vonoprazan-Based Dual Therapy vs Bismuth Quadruple Therapy for Helicobacter Pylori Eradication: Systematic Review, Meta-Analysis, GRADE Assessment, and Trial Sequential Analysis (ACG 2026) - "From 17,661 screened articles, 15 RCTs comprising 4,410 patients were included. Pooled eradication rates were 86.4% with VA and 85.0% with BQT, with no statistically significant difference (RR 1.03, 95% CI 1.00â1.07; p = 0.05; I² = 46.1%). VA significantly reduced total AEs (17.1% vs."

Retrospective data • Review • Infectious Disease

Vonoprazan-Based Triple Therapy Versus Proton Pump Inhibitor Regimens for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis (ACG 2026) - "Forty studies (20 RCTs and 20 observational studies) were included. VPZ-based therapy demonstrated significantly higher eradication rates in both ITT (OR 1.86; 95% CI 1.59-2.17; p< 0.00001; I²=68%) and PP analyses (OR 2.06; 95% CI 1.62-2.63; p< 0.00001; I²=82%). Sensitivity analyses confirmed the stability of pooled estimates."

Retrospective data • Review • Constipation • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Infectious Disease • CYP2C19

Adjunct Vonoprazan in the Treatment of Gastrojejunal Anastomotic Ulcers: A Novel Use (ACG 2026) - "A Stool Guaiac test was positive with a reported history of heavy ibuprofen use, melena, and hematochezia...She was therefore trialed on Vonoprazan 20mg every other day on top of her previous pantoprazole and sucralfate regimen...P-CABs are relatively novel and function via the blockade of potassium binding sites on proton pumps in gastric parietal cells. With a proven effectiveness in H. pylori eradication, additional exploration into their uses, including the treatment of marginal ulcers, is warranted."

Bipolar Disorder • CNS Disorders • Musculoskeletal Pain • Peptic Ulcer

Near-Maximal Acid Suppression With Twice-Daily Low-Dose Vonoprazan: A New Era of Gastric Acid Control? (ACG 2026) - "Values represent percentage of time with intragastric pH >4. Data are derived from pharmacodynamic studies; cross-study comparisons should be interpreted cautiously."

Gastroenterology • Gastrointestinal Disorder

When PPIs Fail: Rapid Resolution of Refractory Post-POEM Esophagitis With Vonoprazan (ACG 2026) - "Pantoprazole was subsequently switched to rabeprazole 20 mg bid but there was no improvement in symptoms and reflux stricturing. Pre-vonoprazan upper endoscopic findings showing (A) ulceration at the gastroesophageal junction and (B) reflux esophagitis with stenosis of the gastroesophageal junction Figure: Figure 2. Upper endoscopic findings obtained 4 months after vonoprazan treatment showing (A) a normal gastroesophageal junction and (B) a normal distal esophagus"

Gastroenterology • Gastrointestinal Disorder • Rare Diseases

Beyond What the Eyes Can See - A Case of Lymphocytic Esophagitis (ACG 2026) - "She was subsequently started on Voquezna for persistent reflux symptoms and Budesonide oral suspension with symptomatic improvement...This case highlights the importance of maintaining clinical suspicion for LE with persistent symptoms despite nonspecific endoscopic findings. Figure: Endoscopy with normal esophageal mucosa"

Clinical • Crohn's disease • Endocrine Disorders • Eosinophilic Esophagitis • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammation • Inflammatory Bowel Disease • Mucositis • Primary Immunodeficiency • Rare Diseases

Proactive Versus Reactive Proton Pump Inhibitor (PPI) Management for Post-Peroral Endoscopic Myotomy (POEM) Objective Gastroesophageal Reflux: A Systematic Review and Network Meta-Analysis (ACG 2026) - "Subgroups:P-CABs like vonoprazan >traditional PPIs p=0.03; benefits >6 months/severe LA C/D... Nine studies n=1420;3 RCTs,6 observational formed connected network proactive,reactive,no PPI. Effect modifiers age,subtype proportions,myotomy length, baseline LA grade comparable transitivity supported. Proactive PPI superior for 12-month healing:RR1.52 95% CrI 1.18â1.96 vs reactive;RR 2.35 95% CrI 1.68â3.28vs no PPI SUCRA 94%."

Retrospective data • Review • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Rare Diseases

Vonoprazan-Based Rescue Regimens Versus Bismuth Quadruple Therapy for Refractory Helicobacter pylori Infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (ACG 2026) - "Three randomized controlled trials comprising 1,278 patients were included. Vonoprazan-based rescue regimens included vonoprazan-amoxicillin dual therapy, vonoprazan-tetracycline dual therapy, and vonoprazan-rifabutin-amoxicillin triple therapy, while comparator arms received BQT rescue regimens. For the primary outcome of ITT eradication, vonoprazan-based therapy demonstrated efficacy comparable to BQT (OR 0.94, 95% CI 0.71-1.25; p=0.662)."

Retrospective data • Review • Infectious Disease

Vonoprazan Is Superior to Proton Pump Inhibitors for Prevention of Upper Gastrointestinal Bleeding in Patients With Atheroembolic Cardiovascular Disease Receiving Antithrombotic (ACG 2026) - "After matching, 6,025 patients were included in each cohort. Baseline characteristics were well balanced after matching, with a mean age of 62.6 ± 14.2 years and 66.5% females. Upper GI bleeding occurred less frequently in the vonoprazan cohort compared with the PPI cohort (4.9% vs 7.9%; aOR 0.60, 95% CI 0.52-0.70; P < .001)."

Clinical • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders

Ultra-Rapid Heartburn Relief and Early Mucosal Healing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Comparing P-CABs and PPIs (ACG 2026) - "These findings are further supported by preliminary data from the US Phase 3 TRIUMpH-EE trial (Sebela Pharmaceuticals, presented DDW 2026), which reported superior Week 2 and Week 8 healing for tegoprazan versus lansoprazole across all LA grades; full peer-reviewed results are pending. Limitations include k=5 RCTs, predominance of Asian populations for vonoprazan data, moderate Day 1 heterogeneity likely reflecting P-CAB agent and population differences, and conference-presentation status of corroborating US data. Larger confirmatory trials and US-specific subgroup analyses will be essential before guideline modification."

Retrospective data • Review • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • CYP2C19

Effectiveness of Vonoprazan in Chinese Patients With Gastroesophageal Reflux Disease: Post Hoc Analysis of a Multicentre, Prospective, Real-World Study (ACG 2026) - P=N/A | "Among the 2,214 patients in the effectiveness population, the cumulative proportion achieving complete symptom relief increased from 13.7â31.4% on Day 1 to 51.8â64.7% by Day 14 across all symptom domains. The â¥50% relief threshold was reached earliest for nocturnal symptoms (nighttime heartburn by Day-5 and nighttime regurgitation by Day 6), followed by all daytime and combined symptoms ( Fig.1A ). The mean percentage of symptomâfree days (Day 1â14) was higher for nighttime vs allâday heartburn (71.19% vs 60.71%), a pattern consistent in the moderate/severe subgroup (57.35% vs 46.75%) and across all demographic and clinical subgroups ( Table 1 )."

Clinical • Real-world • Real-world evidence • Retrospective data • CNS Disorders • Gastroenterology • Gastroesophageal Reflux Disease • Sleep Disorder

Cost-Effectiveness of Vonoprazan Versus Proton Pump Inhibitors in Adults With Erosive Esophagitis in the United States: A Markov Model of Lifetime Outcomes (ACG 2026) - "In all EE patients (N=20,542,209) vonoprazan reduced lifetime cases of esophageal bleeding by 1,853,415, esophageal strictures by 571,982, BE by 420,204, EAC by 34,971, and deaths by 31,158 vs. PPI and was dominant, with savings of $1,361 pp at wholesale price and $4,736 pp at net price ( Table ). Vonoprazan was also dominant in severe EE (N=5,341,490), with savings of $10,004 pp at wholesale price and $14,022 pp at net price (vs."

Clinical • Cost effectiveness • HEOR • Barrett Esophagus • Esophageal Adenocarcinoma • Gastrointestinal Disorder • Solid Tumor

Not All Proton Pump Inhibitors Are Equal: A Head-to-Head Safety Comparison of All Six Oral Agents in 954,252 Propensity-Matched Adults (ACG 2026) - "Six mutually exclusive cohorts excluded other study PPIs, H2-receptor antagonists, or vonoprazan within 1 year before or any time after index. 954,252 patients met criteria (pantoprazole 247,382; omeprazole 562,141; esomeprazole 87,754; lansoprazole 35,077; dexlansoprazole 13,297; rabeprazole 8,601). All post-match standardized mean differences were < 0.10. Dexlansoprazole and rabeprazole showed the lowest adverse-event burden â each significantly more favorable than the other four, with no significant difference between them (RR 1.008, 95% CI 0.927â1.095)."

Clinical • Head-to-Head • Acute Kidney Injury • Alzheimer's Disease • Chronic Kidney Disease • CNS Disorders • Dementia • Hematological Disorders • Infectious Disease • Musculoskeletal Diseases • Nephrology • Orthopedics • Osteoporosis • Pneumonia • Renal Disease • Respiratory Diseases

Smoking Status as the Critical Effect Modifier of P-CAB Superiority Over PPIs in Helicobacter pylori Eradication: A Smoking-Stratified Mantel-Haenszel Meta-Analysis (ACG 2026) - "Among smokers (n842), vonoprazan achieved 86.6% eradication versus 60.8% with PPIs (MH pooled RR=1.43, 95%CI 1.19-1.71, I²=0%, absolute risk difference +25.8%). Among non-smokers (n2,326), vonoprazan achieved 90.2% versus 81.6% with PPIs (MH pooled RR=1.10, 95%CI 1.03-1.19, I²=74.7%, absolute risk difference +8.6%). Formal interaction testing demonstrated significant effect modification by smoking status (Z=2.566, P=0.0103)."

Head-to-Head • Retrospective data • Infectious Disease • CYP2C19

Efficacy and Safety of Vonoprazan-Amoxicillin Dual Therapy Compared With Other Eradication Regimens for Helicobacter pylori Infection: A Systematic Review and Meta-Analysis (ACG 2026) - "Twenty-one RCTs (n=6,574) were included. VADT showed comparable eradication efficacy to controls. For 7-day therapy, eradication did not differ significantly in PP (RR 1.01, 95% CI 0.97â1.05; I²=0%) or ITT analyses (RR 1.00, 95% CI 0.96â1.05; I²=0%)."

Retrospective data • Review • Constipation • Gastroenterology • Gastrointestinal Disorder • Infectious Disease