Potassium-competitive acid blockers effective in GERD patients with severe esophagitis: Study

A recent study that could revolutionize the treatment approach for severe gastroesophageal reflux disease (GERD) unveiled compelling evidence that support the efficacy of Potassium-competitive acid blockers (P-CAB) over the traditional Proton Pump Inhibitors (PPI) in treating grade C/D esophagitis. This severe manifestation of GERD requires active treatment and diligent follow-up due to its significant impact on the quality of life of patients and the potential for progression to more serious conditions. The crucial findings of this study were published in the recent issue of American Journal of Gastroenterology.

The comprehensive study involved a systematic review of randomized controlled trials to compare the healing capabilities and safety profiles of P-CAB and PPI in patients with this advanced stage of esophagitis. After rigorous analysis of data from 5,876 articles, 24 studies were deemed eligible which highlight the effectiveness of three P-CABs (vonoprazan, tegoprazan and keverprazan) against six PPIs (lansoprazole, esomeprazole, omeprazole, rabeprazole extended-release (ER), pantoprazole and dexlansoprazole).

These findings from this exhaustive analysis underlined the superior performance of vonoprazan in achieving both initial and sustained mucosal healing in grade C/D esophagitis patients. With a surface under the cumulative probability ranking score of 0.89 for initial healing and 0.87 for maintained healing, vonoprazan 20 mg once daily (q.d.) was immediately effective than its PPI counterparts which makes it as a potential first-line therapy for this patient demographic.

The study looked into the safety and tolerability of these treatments with a critical consideration for the chronic nature of GERD management. Vonoprazan demonstrated a comparable risk profile to PPIs in terms of adverse events, severe adverse events and drug withdrawal rates making it suitability for long-term use. 10 mg of vonoprazan once daily emerged as a viable and effective option by balancing efficacy with safety for the patients who consider low maintenance doses.

This research highlights the promising role of vonoprazan in the therapeutic landscape of severe esophagitis and emphasizes the need for clinicians to reevaluate the current treatment strategies. Further research and practical implications are required that could ultimately enhance the clinical decision-making which helps in ensuring that patients canreceive the most advanced care possible for their condition.

Reference:

Zhuang, Q., Chen, S., Zhou, X., Jia, X., Zhang, M., Tan, N., Chen, F., Zhang, Z., Hu, J., & Xiao, Y. (2024). Comparative Efficacy of P-CAB vs Proton Pump Inhibitors for Grade C/D Esophagitis: A Systematic Review and Network Meta-analysis. In American Journal of Gastroenterology. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.14309/ajg.0000000000002714