Factors such as cost, access, and lack of long-term safety data may influence how P-CABs are integrated into practice.
Clinicians generally shouldn’t use potassium-competitive acid blockers as first-line therapy for acid-related conditions, nonerosive gastroesophageal reflux disease , or peptic ulcer disease, according to a recent clinical practice update from the American Gastroenterological Association .
Overall, P-CABs appear to be equally as potent or more potent than PPIs, though more potent acid inhibition isn’t necessarily associated with better outcomes, the authors wrote. For most foregut acid-related disorders — such as heartburn and prevention of nonsteroidal anti-inflammatory drug–associated ulcers — P-CABs can help when patients fail PPI therapy.
For erosive esophagitis, P-CABs generally shouldn’t be used for milder cases but can be considered for patients with more severe cases that haven’t responded to PPIs, including refractory esophagitis., P-CABs should be used in place of PPIs for eradication regimens, including among patients with clarithromycin-resistant strains.
Spechler expressed several concerns about the phrasing of the advice statements, particularly ones that lacked direct data, as well as nuances around PPI and P-CAB dosing, efficacy, and safety in clinical studies.
Proton-Pump Inhibitor Acid Suppressive Therapy PPI
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