Potassium-competitive acid blockers and gastroesophageal reflux disease

Abstract

Proton pump inhibitors (PPIs), the most commonly used antisecretory medi-cations in the management of reflux illness, virtually eliminate elective surgery for ulcer disease, and relegate anti-reflux surgery to patients with gastroesophageal reflux disease (GERD) who are inadequately managed by medical therapy. However, PPI medications still leave some therapeutic demands of GERD unmet. Furthermore, up to 40%-55% of daily PPI users have chronic symptoms, due to PPI refractoriness. Potassium-competitive acid blockers (P-CABs) transcend many of the problems and limits of PPIs, delivering quick, powerful, and extended acid suppression and allowing for treatment of numerous unmet needs. Recently, it has become clear that compromised mucosal integrity plays a role in the etiology of GERD. As a result, esophageal mucosal protection has emerged as a novel and potential treatment approach. An increasing body of research demonstrates that when P-CABs are used as primary drugs or add-on drugs (to regular treatment), they provide a considerable extra benefit, particularly in alleviating symptoms that do not respond to PPI therapy.

New achievements of pharmacology for practical medicine in prevention and therapy of acid-dependent diseases

“…ИПП -основные препараты для лечения ГЭРБ, пищевода Барретта, эозинофильного эзофагита, функциональной диспепсии, хронического гастрита, для профилактики и лечения гастропатий, ассоциированных с применением нестероидных противовоспалительных препаратов (НПВП) [28]. Наиболее продолжительные курсы терапии используют для лечения заболеваний пищевода -ГЭРБ, пищевод Барретта, эозинофильный эзофагит [29,30].…”

Acid‐suppressive drugs: A systematic review and network meta‐analysis of their nocturnal acid‐inhibitory effect

“…20 However, potassium-competitive acid blockers (P-CABs) can bind to both resting and activated H + /K + -ATPase, which has a greater acid-suppressive efficacy. 21 P-CABs can be stabilized in the acidic environment of the stomach for at least 8 h, do not need to be formulated into enteric-coated preparations, and absorption is not affected by food. It is mainly metabolized by cytochrome P450 (CYP) 3A4, and the inhibition of acid is less affected by CYP2C19 polymorphism.…”

“…Moreover, a randomized, 3‐period study found tegoprazan produced more rapid, potent and well sustained night‐time acid suppression vs vonoprazan or esomeprazole when administered at night 20 . However, potassium‐competitive acid blockers (P‐CABs) can bind to both resting and activated H + /K + ‐ATPase, which has a greater acid‐suppressive efficacy 21 . P‐CABs can be stabilized in the acidic environment of the stomach for at least 8 h, do not need to be formulated into enteric‐coated preparations, and absorption is not affected by food.…”

Potassium-Competitive Acid Blockers for the Treatment of Gastroesophageal Reflux Disease

“…GERD may also present with atypical features such as chronic cough, chest pain, dental erosions, laryngitis or asthma. [3][4][5] GERD may be classified as erosive esophagitis (EE), non-erosive reflux disease (NERD), and Barrett esophagus (BE). 6 Of these 3 phenotypes, NERD is the most prevalent (60-70%), followed by EE (30%) and BE (6-12%).…”