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World J Gastroenterol. Jul 28, 2022; 28(28): 3608-3619
Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3608
Potassium-competitive acid blockers and gastroesophageal reflux disease
Wattana Leowattana, Tawithep Leowattana
Wattana Leowattana, Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Tawithep Leowattana, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
Author contributions: Leowattana W wrote the paper; Leowattana T collected the data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Wattana Leowattana, MD, MSc, PhD, Professor, Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi Road, Rachatawee, Bangkok 10400, Thailand.
Received: February 16, 2022
Peer-review started: February 16, 2022
First decision: April 12, 2022
Revised: April 24, 2022
Accepted: June 24, 2022
Article in press: June 24, 2022
Published online: July 28, 2022

Proton pump inhibitors (PPIs), the most commonly used antisecretory medi-cations in the management of reflux illness, virtually eliminate elective surgery for ulcer disease, and relegate anti-reflux surgery to patients with gastroesophageal reflux disease (GERD) who are inadequately managed by medical therapy. However, PPI medications still leave some therapeutic demands of GERD unmet. Furthermore, up to 40%-55% of daily PPI users have chronic symptoms, due to PPI refractoriness. Potassium-competitive acid blockers (P-CABs) transcend many of the problems and limits of PPIs, delivering quick, powerful, and extended acid suppression and allowing for treatment of numerous unmet needs. Recently, it has become clear that compromised mucosal integrity plays a role in the etiology of GERD. As a result, esophageal mucosal protection has emerged as a novel and potential treatment approach. An increasing body of research demonstrates that when P-CABs are used as primary drugs or add-on drugs (to regular treatment), they provide a considerable extra benefit, particularly in alleviating symptoms that do not respond to PPI therapy.

Keywords: Potassium-competitive acid blocker, Gastroesophageal reflux disease, Proton pump inhibitors, Treatment outcome, Proton pump inhibitor-refractory patients, Esophageal mucosal resistance

Core Tip: The potassium-competitive acid blocker (P-CAB) has been discovered as a possible acid suppression therapeutic option. At the enzyme level, P-CABs compete with K+ to suppress acid formation; the binding location of these compounds is separate from the probable pocket that K+ occupies. When the P-CAB binds to the enzyme, it stops K+ from attaching and activating it. According to clinical trials, P-CABs are extremely selective for gastric H+, K+-ATPase, restricting stomach acid production while acting quickly. Such medicines, which can have a rapid onset of action and a longer duration, may offer considerable advantages to individuals suffering from gastroesophageal reflux disease and other acid-related disorders.