Himalayan Institute of Medical Sciences

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Extracerebral choroid plexus papilloma in a newborn: a rare presentation
(PUBMED, 2023) Santosh Kumar Singh; Saikat Patra; Nadia Shirazi; Girish Gupta
Choroid plexus papillomas (CPPs) are extremely rare lesions that originate in the central nervous system. Still rarely, these can occur in heterotopic locations. We report a case of aneonate who presented at fourth week of life with a small swelling in the left side of the oropharynx. There were no other symptoms. MRI scan revealed a cystic lesion with the possibility of lymphatic malformation or teratoma. Swelling which was gradually increasing in size was electively excised. Histopathological examination revealed it to be an extracerebral CPP. Postoperative period was uneventful, and baby had no further complications. CPP is a rare lesion and, almost always, cannot be anticipated before surgery. Imaging only helps in surgical planning. Complete excision is curative.
The Missing Link Between Opioid Use Disorder and Seizures During Opioid Withdrawal: A Case Series from North India
(PUBMED, 2023-04-17) Rohit Gondwal1 ,; Priyaranjan Avinash; Robin Victor; Dharuvika
The term “opioids” includes compounds extracted from the poppy plant/pod and semi-synthetic and synthetic compounds with similar properties that can interact with opioid receptors in the brain. These produce mental relaxation, pain relief, and euphoric feelings. Their regular use, abuse, and misuse, often without medical super- vision, can lead to opioid dependence and other health problems. Almost 2.1% of the Indian population uses opioids. The pattern of use varies across different states of India. While the use of inhalational opioid (smack/brown sugar) is much more common in Uttar Pradesh, that of injectable heroin is more common in Punjab and the northeastern states. Percentage-wise, the states of Mizoram and Nagaland are the worst affected by opioid use. The prevalence of opioid use in Uttarakhand is 0.8%. According to an article published in Times of India 2020, there was a record rise in synthetic-drug trafficking in Uttarakhand, especially in our catchment area of Dehradun and the neighboring areas of Rishikesh and Haridwar. Widespread available literature mentions opioid use disorder, intoxication, withdrawal, and other opioid-induced disorders, which include depressive disorder, anxiety disorder, sleep disorder, and sexual dysfunction. However, information is scanty on seizure episodes happening during opioid intake or withdrawal. Few studies have described complicated opioid withdrawal where a seizure occurred along with other features of opioid withdrawal.
Novel variant CPLANE 1: c.5051C>A (p.Ser1684Ter) in an Indian neonate with Joubert syndrome
(BMJ Publishing Group, 2023-05-31) Saikat Patra; Garima Goyal; Yasir Ahmad Lone; Girish Gupta
Joubert syndrome (JS) is a rare ciliopathy that presents with the triad of hypotonia, developmental delay and molar tooth sign (MTS) in brain MRI. Next-generation sequencing has identified about 35 genes which are known to cause JS of which CPLANE 1 mutation is found in 8%-10% of cases. We report a case of JS in an Indian neonate who presented with hypotonia, dysmorphic facies, polydactyly, syndactyly and occipital encephalocele. MRI of the brain revealed MTS, and compound heterozygous mutations in CPLANE 1 gene were detected by clinical exome sequencing, one of them a novel variant CPLANE 1: c.5051C>A (p.Ser1684Ter) in exon 26, which was inherited from the parents.
Effect of Recorded Chants of the “OM” Mantra as an Interventional Music Therapy on Reducing Stress in Newborns Admitted to the Neonatal Intensive Care Unit: An Observational Study
(SAGE Publications, 2023-05-31) Shailendra Kumar Singh; Saikat Patra; Chinmay Chetan; Girish Gupta
Introduction Newborns admitted to the neonatal intensive care unit (NICU) are under tremendous stress. The “OM” sound is known to have a calming effect on adults. The effect of administering chants of “OM” to newborns is unknown. Objectives Primary Objective To evaluate the effect of the “OM” sound on vital parameters in newborns admitted to the NICU. Secondary Objectives To observe the duration of the effect of the “OM” sound on vital parameters after the music therapy and to observe its effect at various gestational ages. Methods Prospective observational study was carried out over 4 months. 57 newborns enrolled were administered music therapy by playing recorded chants of “OM” mantra (MTOM). Vitals were recorded before, during, and after MTOM. Results The heart rate (HR) before and with MTOM was 142 ± 7 and 130 ± 11 bpm (p = .001). The decrease in HR persisted even after 1 h of stoppage of MTOM (p = .001). A significant decrease in HR was observed in all gestations (p = .001). There was no significant difference in respiratory rate (RR) and SpO2 before and with MTOM. Conclusion MTOM significantly reduces HR in newborns of all gestational ages, and its effect persists for at least 1 h after stopping MTOM.
Effectiveness of Probiotics and Phototherapy Compared to Phototherapy Alone in Treating Hyperbilirubinemia in Neonates ≥35 Weeks Gestation: A Comparative Observational Study
(SCOPUS, 2023-06-01) Suraj Kumar Singh; Girish Gupta; Sanober Wasim; Rakesh Kumar; Saikat Patra; Chetan Chinmay
Introduction Neonatal jaundice is a common condition in neonatal practice. Phototherapy is accepted first line of therapy in its treatment. Probiotics can be an addition as it decreases enterohepatic circulation and improves gut function. Materials and Methods The observational study was conducted in 40 neonates. Participants were divided into 2 groups, phototherapy alone (PA) and probiotics plus phototherapy (PP). The mean difference in total serum bilirubin (mg/dL) levels, total duration of phototherapy, incidence of rebound hyperbilirubinemia, frequency of stooling after initiation of therapy, feed intolerance, and occurrence of new onset sepsis was compared. Results The mean difference in serum bilirubin level was not statistically significant after 12 hours (p = .321), 24 hours (p = .544) and 48 hours (p = .863) after initiation of phototherapy. An increase in frequency of stool in the first 24 hours was observed in PP group (p = .003). The total duration of phototherapy was less in PP group although not statistically significant (25 hours vs 38 hours, p = .054). Rebound hyperbilirubinemia was significantly higher in PA (p = .023). There were no cases of feed intolerance and sepsis. Conclusion The addition of probiotics did not alter the clinical course of jaundice. However, probiotics can reduce the rebound hyperbilirubinemia and is safe as it did not increase incidence of new onset sepsis or feed intolerance.
Usefulness of Mean Gastric Emptying Time in Late Preterm and Term AGA and SGA Newborns to Determine Feeding Frequency—An Observational Study
(SAGE Publications, 2023-06-14) Ankit Jain; Saikat Patra; Vinayak Madhukar Jedhe; Chinmay Chetan; Girish Gupta
Objectives The primary objective is to calculate and compare mean gastric emptying time in appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. The secondary objective is to compare mean gastric emptying time in SGA babies with or without antenatal Doppler changes and to measure gastric spheroidal volume at various intervals in AGA and SGA newborns with or without antenatal Doppler changes. Methods This prospective observational study was carried over 3 months from November 2022 to January 2023. A total of 30 newborns were enrolled and their gastric spheroidal volume was calculated by ultrasound pre-feed and post-feed every 30 minutes till it reached within 10% of pre-feed volume which was taken as gastric emptying time. Mean gastric emptying time was compared among AGA and SGA newborns and amongst SGA with or without antenatal Doppler changes. Results Mean gastric emptying time of AGA was 124 ± ± 25.01 minutes and for SGA was 132 ± 29.57 minutes which was statistically nonsignificant. Mean gastric emptying time when compared between SGA neonates with or without antenatal Doppler changes was similar (P value .43). The gastric spheroidal volume was significantly smaller in SGA newborns compared to their AGA counterparts in pre-feed state (P value .01) and it persisted till 60 minutes post feed (P value .028); however, the mean gastric emptying time is similar in both the groups. Conclusion Mean gastric emptying time of AGA and SGA newborns is similar and hence a feeding interval of 1.5 to 2.5 hours is appropriate for these late preterm and term newborns. Antenatal Doppler changes in SGA babies did not alter their gastric emptying time hence similar feeding frequency can be used in both.
Double BCG vaccination in a neonate: implications, management and prevention
(PUBMED, 2023-12-01) Chinmay Chetan; Saikat Patra; Shailendra Kumar Singh; Girish Gupta
Tuberculosis is a common cause of morbidity and mortality especially in low-income and middle-income countries like India. BCG vaccination is recommended for all neonates after birth in areas with a high tuberculosis disease burden. Here, we describe a case where a neonate received two doses of the BCG (Chennai strain) vaccine within a span of 4 days after birth due to a vaccination error. Parents were informed about the event. The infant was managed conservatively and followed up till 12 months of life for any possible complication. There were no serious adverse effects apart from the localised reaction and a double scar on the left arm. Measures to avoid any such error in the future and the need for reporting medication error has been highlighted. Parental concerns are frequent in such scenarios and should be actively addressed.
Usefulness of skills in point of care ultrasound and simulation-based training as essential competencies in acute management of neonatal cardiac tamponade
(BMJ Publishing Group, 2023-12-29) Ankit Jain; Saikat Patra; Chinmay Chetan; Girish Gupta
Peripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.
Natural Language Processing in Biomedical Literature for Analysing the Effects of Neurodynamic in Pain and Disability in Carpal Tunnel Syndrome
(International Journal on Recent and Innovation Trends in Computing and Communication, 2024) Aditi Kuliyal; Manish Kumar Jha; Vaibhav Agarwal; Arun Pathak
Carpal tunnel syndrome (CTS) a most common peripheral neuropathy characterized by numbness, tingling in the sensory distribution area of the of the median nerve, particularly in the thumb , index finger ,middle finger and radial side of ring finger along with motor weakness, distal to wrist that results into decreased hand grip strength and hand function disability. CTS puts an economy burden on healthcare services as its incidence and prevalence are increasing day by day although a slight decline in numbers has been seen over a period time. Fuzzy logic retains expert information in an intelligent system that maybe effectively utilized by others, simulating the cognitive decision-making abilities of the specialist, and helping junior doctors with less expertise make better diagnoses. Therefore, the use of such an expert system is advised to speed up and enhance the accuracy of the diagnosis in patients with suspected CTS by studying different literatures. To device, evidence based therapeutic protocol from biomedical literature for the treatment of pain and disability in CTS. To analyse the effect of openers, sliders, and tensioners on NPRS and disability in carpal tunnel syndrome, using biomedical literature. Therefore, we draw the very encouraging conclusion that further research on the application of such a fuzzy expert system for medical opinion prediction and diagnosis is warranted
Neonatal nephrotic syndrome: all is not gloomy
(BMJ Publishing Group, 2024-01-02) Chinmay Chetan; Shailendra Kumar Singh; Saikat Patra; Girish Gupta
Congenital nephrotic syndrome (CNS) is a rare clinical syndrome with a constellation of proteinuria, hypoalbuminemia and oedema, presenting within 3 months of birth. We present a rare case of neonatal nephrotic syndrome with a probable sepsis induced aetiology. The neonate was referred at day of life 15 with Klebsiella pneumonia sepsis and anasarca. On investigation, the patient had nephrotic range proteinuria, hypoalbuminemia, generalized anasarca and ascites. The neonate was started on broad-spectrum antibiotics and furosemide. Genetic and other secondary causes of CNS were ruled out. With supportive management and resolution of sepsis, the neonate improved. This case highlights the rare cause of sepsis-induced nephrotic syndrome (NS), which required only supportive treatment without the need for aggressive management of CNS.
To study the survival analysis and recurrence pattern in women treated for breast cancer: Retrospective study, a tertiary cancer center experience from Sub‐Himalayan Region of India
(Wiley, 2024-01-04) Shivangi Sundram; Sourabh Nandi; Anshika Arora; Sunil Saini
Background: Breast cancer is a leading health concern in India, comprising 25% of female cancers with significant mortality. This study was conducted at the Cancer Research Institute in the Northern Sub‐Himalayan region of India from 2016 to 2021, evaluated 674 breast cancer cases to analyze factors that influence recurrence. Methodology: Retrospective clinical audit assessing patients’ survival outcomes using Kaplan–Meier curves and Cox proportional hazard regression. Factors including age, molecular subtype, TNM staging, and treatment modalities were evaluated. Results: Notable findings include a high occurrence of breast cancer in young patients (24.48% ≤ 40 years) and varying recurrence rates among molecular subtypes with human epidermal growth factor receptor 2 neu‐enriched (25.24%) and triple‑negative breast cancer (22.58%) being the most common. Advanced T and N stages, neoadjuvant chemotherapy, and the number of nodes dissected showed significant associations with higher recurrence rates. Conclusion: This study sheds light on survival and recurrence patterns in Northern Sub‐Himalayan breast cancer patients, emphasizing the need for tailored treatment strategies, comprehensive follow‐up care, with improved understanding of regional outcomes. These findings contribute valuable insights for optimizing patient care and improving survival rates in this region.
Yellow Fibrous Cord‑Like Penile Discharge in a Preterm Neonate — Fungal Balanoposthitis
(PUBMED, 2024-03-01) Chinmay Chetan; Saikat Patra; Brajendra Singh; Girish Gupta
A 1785 g male neonate was born at 31 wk gestation, to an inadequately treated syphilitic mother. The neonate was diagnosed with congenital neurosyphilis. Injection benzathine penicillin G stat dose along with injection ceftriaxone was started through peripherally inserted central catheter. At DOL 24 he developed thick yellowish cord-like gelatinous odourless discharge from the penis, measuring 9 mm×4 mm (Fig. 1). Physiological phimosis was present, with no signs of inflammation and urinary retention. No perianal rashes were noted. Oral thrush was present. Histopathological examination of discharge and suprapubic urine KOH mount revealed budding yeast cells with pseudohyphae. Local clotrimazole cream and injection fluconazole was started. Local hygiene was maintained. The discharge culture grew Candida albicans sensitive to fluconazole.
Alarming medication error with prostaglandin E1 (PGE1) in a term neonate with critical congenital heart disease
(BMJ case report, 2024-04-08) Saikat Patra; Prachi Patwal; Chinmay Chetan; Girish Gupta
An outborn full-term female newborn with birth weight 2.45kg was admitted to our centre at 24 hours of life with respiratory distress and cyanosis. The baby had tachycardia and oxygen saturation (SpO2 ) 40% at admission to neonatal intensive care unit (NICU). She was mechanically ventilated on synchronized intermittent mandatory ventilation (SIMV) mode. Clinical evaluation raised suspicion of critical congenital heart disease; echocardiogram revealed transposition of the great arteries with 6mm ostium secundum atrial septal defect and small patent ductus arteriosus. The baby was started only on intravenous prostaglandin E1 (PGE1) as per unit protocol, where 1 ampoule (500 µg) of PGE1 is mixed in 49mL of 5% dextrose yielding a concentration of 10 µg/mL and is then started using an infusion pump at a rate of 0.6mL/kg/hour to provide a dose of 0.1 µg/kg/min. She developed tachycardia along with confluent erythematous macules over the scalp, face, neck and trunk, 10 hours after starting PGE1 infusion (figure 1). There was no associated fever or hypertension, while lowest blood pressure recorded was 52/30mm Hg. The skin rash, characterised by bright erythematous macular lesions, rapidly spread to the extremities. It was noticed that PGE1 was wrongly administered at 10 times the expected dose for the last 2hours prior to the cutaneous manifestation. The infusion was immediately stopped, and the baby was given
Comparative performance of biofire pneumonia panel and standard culture-based methods for diagnosing pneumonia in critically ill patients: Impact on antibiotic stewardship
(Elsevier, 2024-04-22) Barnali Kakati; Rajender Singh; Garima Mittal; Nupur Koul
Introduction: Lower respiratory tract infections (LRTIs) are a common cause of morbidity and mortality worldwide. Accurate identification of the pathogens causing LRTIs is crucial for ensuring of diagnostic and antibiotic stewardship. The Biofire Pneumonia Panel (BFPP) is a molecular diagnostic test that allows rapid detection of various bacterial and viral pathogens. In this study, we compared the performance of BFPP with standard culture methods for the detection of pathogens. Materials and methods: Respiratory samples from 70 patient with suspected LRTIs were tested using both BFPP and standard culture methods. The distribution of isolated bacterial pathogens was analyzed, and the sensitivity and specificity of BFPP were calculated. Additionally, the performance of BFPP in detecting antimicrobial resistance genes was evaluated. The results were compared with those obtained from VITEK-2 antimicrobial susceptibility testing and culture-based methods. Results: Among the suspected LRTI cases, BFPP identified a single pathogen in 32.8% of cases and multiple pathogens in 40% of cases. The standard culture method detected a single pathogen in 47.1% of cases. BFPP showed a sensitivity of 93.9% and a specificity of 45.9% for the total sample. The performance of BFPP in detecting antimicrobial resistance genes varied for different pathogens with overall sensitivity of 40.1% and specificity of 95.9%. Conclusion: The Biofire Pneumonia Panel (BFPP) demonstrated high sensitivity for several bacterial pathogens, indicating its potential as a rapid diagnostic tool. However, its performance varied for different microorganisms, and it had limitations in detecting certain pathogens and antimicrobial resistance genes for which still required more further studies to explore different resistance gene mechanism that can be incorporated in this panel in future. The BFPP can complement standard culture methods as a rapid tool in the diagnosis of LRTIs
Duplicated Ureter: A Rare Anatomical Variation Diagnosed Incidentally During Open Radical Hysterectomy for Carcinoma Endometrium and Avoidance of Mishappening: A Case Report
(Springer, 2024-04-24) Shivangi Sundram; Sourabh Nandi
This case report presents a rare anatomical variation known as double ureter, where a comprehensive unilateral duplication of the left ureter originating from a single renal tissue was incidentally discovered during staging laparotomy for CA endometrium. This congenital anomaly significantly heightens the possibility of unintentional damage to the ureter during surgeries involving the pelvic area. In summary, ensuring careful exposure of both ureters along with the continuous vigilance of surgeons remains pivotal for ensuring a secure surgical procedure.
Infective Endocarditis due to Unusual Pathogens Complicated with Pulmonary Thromboembolism: A Rare Occurrence in a Premature Infant
(SCOPUS, 2024-05-13) Saikat Patra; Prachi Patwal; Chinmay Chetan; Girish Gupta
Background: Survival of low birth weight preterm neonates has increased with the availability of better neonatal care, however, the use of central lines for longer duration increases the risk of bacterial and fungal sepsis. Neonatal infective endocarditis (IE) is a rare presentation of neonatal sepsis and is often associated with complications and high mortality. Clinical Description: A 36 weeker, premature baby, hospitalized for early onset sepsis, was transferred to our hospital on day 15 of life, with an umbilical catheter in situ, with fever, respiratory distress, and persistent thrombocytopenia. Clinical examination revealed decreased oxygen saturation, crepitations in the right lung field, systolic murmur, and hepatomegaly. Management and Outcome: Baseline investigations revealed positive septic screen with thrombocytopenia with meningitis, neonatal cholestasis, and right sided consolidation on chest X ray. A two dimensional echocardiography (ECHO) revealed vegetation on the tricuspid valve, and blood culture from two sites revealed growth of Candida tropicalis and Serratia marcescens. Colistin, tigecycline, and amphotericin B therapy were initiated as per sensitivity along with low molecular weight heparin for prevention of embolization. The baby developed acute worsening in respiratory distress after 4 weeks of therapy. Repeat ECHO revealed increased size of cardiac vegetation and computed tomography of thorax with pulmonary angiography revealed pulmonary thromboembolism. Unfortunately, the baby succumbed to complications of IE. Conclusion: Invasive instrumentations such as umbilical catheterization and prolonged hospitalizations of premature newborns predispose them to develop IE, especially with unusual organisms. Such infections have a complicated course and may be fatal.
Unraveling Patterns of Congenital Structural Malformations in Infants: A Hospital-Based Descriptive Study
(PUBMED, 2024-05-15) Savita Pandey; Yasir A. Lone; Saikat Patra; Braham P. Kalra; Sanyam Modi
Introduction Congenital malformation studies serve several purposes, including establishing baseline rates, monitoring changes over time, exploring the origins of these defects, and helping in planning health services. Increasing public awareness about pediatric surgical interventions is another goal of these studies. However, the impact of congenital malformations is often underestimated in developing countries due to insufficient healthcare data and diagnostic facilities, particularly in rural areas. Families affected by the birth of a child with congenital malformations face significant stress and hardship. Methods The main aims of this study were to evaluate the clinical pattern of congenital structural malformations in our region (Uttarakhand, India), identify possibly associated factors of congenital malformations, and find out the immediate outcome of congenital malformations in enrolled participants. Results Among a total of 150 cases, 73 (48.7%) cases were inborn, whereas 77 (51.3%) cases were outborn. Investigation of congenital malformation revealed cleft lip or palate in 37 (24.7%) cases, congenital heart disease (CHD) in 33 (22%) cases, meningomyelocele (MMC) in 18 (12.0%) cases, anorectal malformation (ARM) in 11 (7.3%) cases, hypospadias in 10 (6.7%) cases, congenital talipes equinovarus (CTEV) in nine (6.0%) cases, tracheoesophageal fistula (TEF) in nine (6.0%) cases, polydactyly in seven (4.7%) cases, pelviureteric junction obstruction (PUJO) in four (2.7%) cases, duodenal atresia in three (2.0%) cases, midgut volvulus in three (2.0%) cases, umbilical sinus in two (1.3%) cases, sacrococcygeal teratoma (SCT) in one (0.7%) case, phimosis in one (0.7%) case, microtia in one (0.7%) case, and micrognathia in one (0.7%) case. Mortality was observed in 11 (7.3%) cases, whereas 105 (70%) cases were successfully discharged. Among 11 mortality cases, the cause of death was CHD in seven (63.2%) cases, TEF+CHD in two (18.1%) cases, MMC in one (9%) case, and duodenal atresia in one (9%) case. Conclusion Contrary to the common belief that advanced maternal age of greater than 35 years is a major cause, 86.6% of the congenital structural anomalies in our hospital-based study in Uttarakhand occurred in babies of mothers belonging to the age group of 18-30 years. Also, consanguineous marriage was observed in only 3.3% of cases, indicating that it may not be a major contributing factor causing congenital structural malformations in our region. External congenital anomalies are most commonly observed (60.7%), with cleft lip and cleft palate being the most common. The most frequently observed internal congenital anomaly is CHD (22%) followed by gastrointestinal (GI) (18.6%) and urinary anomalies (10.1%). Death and referral are commonly seen in CHD.
Assessment of Central Catheter Tip Position in Neonates by Ultrasonography Versus X-ray
(SCOPUS, 2024-06-01) Prachi Patwal; Chinmay Chetan; Brajendra Singh; Vinayak Madhukar Jedhe; Girish Gupta
Central catheters are frequently inserted in neonatal intensive care units. The tip of these catheters should be in the correct position; otherwise, it may lead to life-threatening complications. X-ray has been universally used as a standard imaging modality to localize the position of central lines. Ultrasonography is an upcoming promising modality. We compared the catheter tip localization using ultrasonography versus X-ray.
Dual fluid silhouette in X-ray of the abdomen: a diagnostic flag for neurogenic bladder with urinary ascites
(PUBMED, 2024-06-04) Brajendra Singh; Chinmay Chetan; Aisha Naaz; Girish Gupta
A neonate presented with abdominal distension and decreased urinary output. X-ray revealed dual abdominal fluid condition-ascites with a distended bladder, along with vertebral anomalies. The possibility of urinary ascites and neurogenic bladder was kept, which was further confirmed on evaluation. Here, we emphasise the crucial role of abdominal X-ray as a diagnostic tool in uncovering this intricate medical puzzle. By detailing the clinical presentation, diagnostic approach and treatment strategy, the report contributes insights into the rare and complex abdominal condition.
Vonoprazan causes symptomatic improvement in non-erosive gastroesophageal reflux disease: A systematic review and meta-analysis
(Elsevier, 2024-06-06) Sanjay Bandyopadhyay; Pooja Verma; Shambo Samrat Samajdar; Saibal Das
Objective: To evaluate the efficacy and safety of vonoprazan therapy as compared to conventional proton pump inhibitors (PPIs) or no vonoprazan for non-erosive esophagitis. Methods: A thorough search was conducted across databases. The primary outcome was to determine the mean variance in the gastroesophageal reflux disease (GERD) score after vonoprazan treatment. Secondary outcomes comprised alterations in the scores for epigastric pain and post-prandial distress, the proportion of patients displaying improvement, and the occurrence of adverse events. Pooled mean differences and relative risks were determined utilizing random effects models. Results: A total of 1,944 articles were screened and nine of them were included. As compared to PPI or no vonoprazan therapy, vonoprazan treatment led to a significant reduction in the GERD score [mean difference: -3.88 (95 % CI: -5.48, -2.28), p < 0.01, i 2 =95 %]. As compared to PPI or no vonoprazan therapy, vonoprazan treatment led to a significant reduction in the epigastric pain score [mean difference: -3.02 (95 % CI: -5.41, -0.63), p = 0.01, i 2 =75 %] and post-prandial distress score [mean difference: -2.82 (95 % CI: -3.51, -2.12), p < 0.01, i 2 =0 %] (all moderate GRADE evidence). Vonoprazan therapy was found to be safe. Conclusion: Treatment with vonoprazan could significantly improve symptoms in patients with non-erosive esophagitis or non-erosive GERD.