The Role of P-CABs in GERD

Potassium-competitive acid blockers (P-CABs) constitute a relatively new class of gastric acid-suppressing drugs. Among this class, vonoprazan is the first to have been approved in the United States. However, some P-CABs including vonoprazan, tegoprazan, and fexuprazan have been available in other countries since at least 2014. The first aim of this article is to review pharmacological differences between P-CABs that are currently approved or in development with proton pump inhibitors. The specific focus thereafter is on the likely role of P-CABs in the treatment of different manifestations of gastroesophageal reflux disease. Multiple clinical trials have compared P-CABs with proton pump inhibitors in erosive esophagitis. Additional trials have compared P-CABs with placebo in nonerosive reflux disease. Relevant results are reviewed, and inferences are drawn for their use in the United States. Finally, consideration is given to additional, potential uses of P-CABs in the broader spectrum of gastroesophageal reflux disease, and some suggestions are made for future research initiatives.