The Efficacy of Potassium-Competitive Acid Blocker Compared With Double Dose of Proton Pump Inhibitor in Patients...

A significant number of patients with gastroesophageal reflux disease (GERD) experience refractory symptoms despite conventional doses of a proton pump inhibitor (PPI). Potassium-competitive acid blockers (PCABs) directly inhibit H+,K+-ATPase in a reversible manner and more profoundly inhibit acid secretion. However, the efficacy of PCABs in the treatment of refractory symptoms has not been thoroughly studied.

This consecutive study was conducted between March 2020 and March 2023; patients with refractory symptoms were enrolled. Esophagogastroduodenoscopy, ambulatory esophageal pH measurements, and manometry were performed. Double split doses of rabeprazole (20 mg) or tegoprazan (50 mg) were prescribed for 2 weeks, and the symptoms were subsequently evaluated. A positive response was defined as more than 50% improvement in the visual analog scale scores for symptom severity.

A total of 63 patients were enrolled. In the group that received a double split dose of PPI (n=33), the positive response rate was 63.6% (21/33). There were 18 cases of abnormal acid exposure (excessive esophageal acid exposure time [AET] >4.0%); the positive response rate was 50.0% (9/18). In the group treated with PCAB (n=30), the positive response rate was 80.0% (24/30) (p=0.15). There were 19 cases of abnormal acid exposure; the positive response rate was 84.2% (16/19). The difference was statistically significant in favor of the PCAB group (p=0.02).

In patients with refractory GERD symptoms, PCAB therapy had effects corresponding to those of a double split dose of PPIs. PCAB therapy was therefore deemed superior to PPIs, especially in patients with abnormal AETs.