Published online Jul 28, 2022. doi: 10.3748/wjg.v28.i28.3608
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.
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.