Potassium-competitive acid blockers

Acid suppression is the mainstay of management of common foregut disorders, including gastroesophageal reflux disease (GERD), peptic ulcer disease and Helicobacter pylori infection. Drawbacks of standard management with proton pump inhibitors (PPIs) include acid lability requiring enteric coating, slow onset of effect, lack of suppression of nocturnal acid breakthrough, and need for administration before meals.

Potassium-competitive acid blockers (PCABs) are a novel class of acid suppressants that are effective in the management of symptomatic and erosive GERD, peptic ulcer disease and H. pylori infection. Administration before meals is not needed, and these agents achieve profound acid suppression right from the first dose, with control of daytime as well as nocturnal acid. In randomized controlled trials, PCABs are noninferior and often superior to PPIs, especially in healing of advanced grade esophagitis and eradication of treatment-naive as well as refractory H. pylori. The safety profile of PCABs over 10 years of use is reassuring, although profound acid suppression may contribute to hypergastrinemia and increased risk of gastrointestinal infections.

As PCABs become available in many countries around the globe, real-world use will allow further research to determine the clinical niche of these acid-suppressive agents.