SynthesisJournal of neurogastroenterology and motility2026
Potassium-competitive Acid Blockers in Gastroesophageal Reflux Disease and Functional Dyspepsia: A Korean Expert Review With Original Meta-analyses.
Synthesis in Journal of neurogastroenterology and motility, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Potassium-competitive acid blockers (P-CABs) have emerged as a potent alternative to proton pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease and functional dyspepsia (FD). This narrative review incorporating original meta-analyses summarizes the latest evidence from randomized controlled trials and meta-analyses, emphasizing the efficacy, safety, and clinical applications of P-CABs such as vonoprazan, tegoprazan, fexuprazan, keverprazan, and zastaprazan. P-CABs demonstrate rapid onset, sustained acid suppression, and superior healing rates in erosive esophagitis (EE), particularly in severe EE (grade C/D). Maintenance therapy in healed EE with P-CABs also yields higher endoscopic remission rates compared to PPIs. In non-erosive reflux disease, P-CABs offer rapid and sustained symptom control compared with placebo. Their pharmacologic profiles, including flexible dosing and rapid action, support on-demand therapy, potentially enhancing patient satisfaction. In addition, P-CABs may help overcome unmet needs from suboptimal efficacy of PPIs in nocturnal heartburn and extraesophageal symptoms. Emerging economic evaluation suggests P-CABs may be cost-effective in Asian healthcare systems. In FD, tegoprazan offers effective symptom relief without delaying gastric emptying, distinguishing it from PPIs. Limited clinical and real-world data indicate that second-generation P-CABs do not exhibit significant hepatotoxicity, however, long-term hypergastrinemia and mucosal changes warrant further surveillance. This review highlights the evolving role of P-CABs in gastroesophageal reflux disease and FD and emphasizes the need for further research to refine their clinical positioning, optimize therapeutic strategies, and evaluate long-term safety outcomes.
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