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The potential role of potassium-competitive acid blockers in the treatment of gastroesophageal reflux disease

Scarpignato, Carmeloa,b,c; Hunt, Richard H.d

Current Opinion in Gastroenterology: July 2019 - Volume 35 - Issue 4 - p 344–355
doi: 10.1097/MOG.0000000000000543
ESOPHAGUS: Edited by Stuart J. Spechler

Purpose of review Gastroesophageal reflux disease (GERD) is primarily a motor disorder, but its pathogenesis is multifactorial. Although gastric acid secretion is usually normal in GERD patients, treatment with proton pump inhibitors (PPIs) has become the standard of care, despite increasing awareness of their shortcomings. In this article, a new class of antisecretory drugs (namely potassium-competitive acid blockers, P-CABs), developed to overcome these limitations, is discussed.

Recent findings P-CABs block the K+ exchange channel of the proton pump, resulting in rapid, competitive, reversible inhibition of acid secretion. These drugs offer a more rapid elevation of intragastric pH than PPIs, while maintaining similar antisecretory effect, the duration of which is dependent on half-life and can be prolonged with extended release formulations. Thus, P-CABs offer advances in the treatment of GERD including rapid heartburn relief, faster and more reliable healing of severe grades of erosive esophagitis, as a consequence of better control of nighttime acid secretion than PPIs.

Summary P-CABs overcome many of the drawbacks of PPIs. The unique antisecretory effects of vonoprazan might be especially useful in the long-term treatment of patients with Barrett's esophagus.

aUnited Campus of Malta, Birkirkara, Malta

bFaculty of Medicine, Chinese University of Hong Kong, Ma Liu Shui, Hong Kong

cDepartment of Medicine & Surgery, University of Parma, Parma, Italy

dDivision of Gastroenterology and Farncombe Family Digestive, Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Correspondence to Carmelo Scarpignato, MD, DSc, PharmD, MPH, FRCP (Lond), FACP, FCP, FACG, AGAF, FEBGH, Professor of Gastroenterology, United Campus of Malta, Birkirkara, Malta; Associate Professor of Gastroenterology, University of Nantes; Honorary Clinical Professor, Chinese University of Hong Kong, Ma Liu Shui, Hong Kong; Adjunct Professor of Clinical Pharmacology; University of Parma, Parma, Italy. Tel: +39 348 3902106; e-mail:, ORCID ID: 0000-0001-5645-857X

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