Spider Web-like mucus pattern after vonoprazan usage- What contributes to its formation?
A recent groundbreaking study published in the journal Biomedical Reports found that vonoprazan (VPZ) usage was associated with a web-like mucus pattern that is unrelated to the duration of the drug use.
The increasing prevalence of gastroesophageal reflux disease led to the use of acid blockers like vonoprazan (VPZ) and proton pump inhibitors (PPIs). Vonoprazan is a potassium-competitive acid blocker (PCAB) that reversibly inhibits gastric acid output through K+-competitive ionic binding to H+/K+-ATPase. There was a steady increase in the prescription of this drug owing to its effectiveness in treating reflux esophagitis, eradicating Helicobacter pylori (HP), treating gastric and duodenal ulcers, and even treating post-endoscopic submucosal dissection ulcers. Literature has shown that web-like mucus patterns develop in the stomach when vonoprazan (VPZ) is used. Hence, researchers from Jichi Medical University, Japan studied the prevalence and associated factors of web-like mucus in the stomach with vonoprazan (VPZ) usage.
A retrospective observational study was carried out on the medical records and endoscopic reports of 547 patients who underwent an esophagogastroduodenoscopy. Ultra-thin endoscopy recorded acid blocker use, gastric atrophy grading, and gastric abnormalities, including web-like mucus. Web-like mucus is a solid adhesion resistant to washing that is observed in endoscopic findings.
Findings:
- The overall prevalence of web-like mucus was 6% (33/547), with 97% (32/33) of these patients being VPZ users.
- About 19% (32/167) of VPZ users developed web-like mucus patterns.
- The web-like pattern was more significantly seen in the VPZ group than in the control (no acid blocker intake), proton pump inhibitor, and histamine-2 receptor antagonist groups.
- As per the multivariate analysis, VPZ was positively associated with web-like mucus, while open-type gastric atrophy and multiple white and flat elevated lesions were negatively associated.
- A retrospective analysis of the previous endoscopic findings showed that a web-like mucus pattern was not seen previously in the 32 VPZ users who had initiated VPZ therapy.
- In the Cochran-Armitage trend test, no significant association was found between VPZ therapy duration and web-like mucus prevalence.
Thus, the researchers concluded that web-like mucus in the stomach is strongly associated with VPZ use but not with the duration of VPZ therapy. This unique web-like pattern is the potential endoscopic diagnostic marker and helps differentiate VPZ-induced gastric changes from other conditions.
Further reading: Shinozaki, Satoshi et al. “Prevalence and factors associated with web‑like mucus in the stomach after vonoprazan use.” Biomedical reports vol. 22,2 33. 10 Dec. 2024, doi:10.3892/br.2024.1911.
