Evolving landscape of potassium-competitive acid blockers: toward disease-specific use beyond acid suppression

Potassium-competitive acid blockers (P-CABs) represent a major advancement in acid suppression by achieving rapid and sustained inhibition of gastric acid secretion. However, stronger acid suppression does not necessarily lead to better clinical outcomes. The clinical benefits of P-CABs vary according to the disease. In gastroesophageal reflux disease, P-CABs achieve healing rates for erosive esophagitis that are comparable to those of proton pump inhibitors (PPIs), with possible advantages in severe cases; however, consistent superiority in symptom control is lacking. The evidence for functional dyspepsia also remains insufficient. By contrast, in Helicobacter pylori eradication, P-CAB-based regimens have demonstrated clear advantages, particularly in the presence of antibiotic resistance. In peptic ulcer disease, the efficacy of P-CABs is comparable to that of PPIs. Long-term safety, including the effects of sustained hypergastrinemia, remains uncertain. Furthermore, symptom improvement and mucosal healing are not always concordant, thus highlighting the need to define therapeutic goals. Therefore, P-CABs should be used selectively on the basis of disease-specific requirements rather than pharmacological potency alone. An individualized approach is essential to optimize outcomes and avoid the unnecessary escalation of acid-suppressive therapy.